Healthcare Provider Details

I. General information

NPI: 1407803083
Provider Name (Legal Business Name): MICHAEL JOHN MOFFETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL JOHN MOFFETT M.D.

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 MEDICAL CENTER DRIVE WEST 221
CLOVIS CA
93611
US

IV. Provider business mailing address

729 N MEDICAL CENTER DR W STE 221
CLOVIS CA
93611-6885
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-6600
  • Fax: 559-326-2530
Mailing address:
  • Phone: 559-299-6600
  • Fax: 559-326-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG80577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: