Healthcare Provider Details

I. General information

NPI: 1346205929
Provider Name (Legal Business Name): JAMES W MOFFITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 KENTUCKY ST
ASHLAND KS
67831-3199
US

IV. Provider business mailing address

625 KENTUCKY ST
ASHLAND KS
67831-3199
US

V. Phone/Fax

Practice location:
  • Phone: 620-635-2241
  • Fax: 620-635-2229
Mailing address:
  • Phone: 620-635-2241
  • Fax: 620-635-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number44600
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0428121
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number44600
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-28121
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: