Healthcare Provider Details

I. General information

NPI: 1043203334
Provider Name (Legal Business Name): RONALD TAI YOUNG MOON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 UNIVERSITY BLVD
BIRMINGHAM AL
35233-1111
US

IV. Provider business mailing address

820 UNIVERSITY BLVD
BIRMINGHAM AL
35233-1111
US

V. Phone/Fax

Practice location:
  • Phone: 205-327-5030
  • Fax: 205-327-5616
Mailing address:
  • Phone: 205-327-5030
  • Fax: 205-327-5616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberDO-419
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: