Healthcare Provider Details

I. General information

NPI: 1265405039
Provider Name (Legal Business Name): THOMAS E MOODY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3485 INDEPENDENCE DR
HOMEWOOD AL
35209-5603
US

IV. Provider business mailing address

3485 INDEPENDENCE DR
HOMEWOOD AL
35209-5603
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-0920
  • Fax: 205-445-0115
Mailing address:
  • Phone: 205-930-0920
  • Fax: 205-445-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number7582
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number00007582
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: