Healthcare Provider Details

I. General information

NPI: 1518222132
Provider Name (Legal Business Name): MOOSE HAND CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10502 PARK RD SUITE 170
CHARLOTTE NC
28210-8479
US

IV. Provider business mailing address

10502 PARK RD SUITE 170
CHARLOTTE NC
28210-8479
US

V. Phone/Fax

Practice location:
  • Phone: 704-372-0527
  • Fax: 704-372-7564
Mailing address:
  • Phone: 704-372-0527
  • Fax: 704-372-7564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number32543
License Number StateNC

VIII. Authorized Official

Name: DR. DURMAN WILLIAM MOOSE JR.
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 704-372-0527