Healthcare Provider Details

I. General information

NPI: 1548268238
Provider Name (Legal Business Name): JOANNE M MOFF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST STE 1480
DAYTON OH
45409-2939
US

IV. Provider business mailing address

30 E APPLE ST STE 1480
DAYTON OH
45409-2939
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-3220
  • Fax: 937-208-3633
Mailing address:
  • Phone: 937-208-3220
  • Fax: 937-208-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50001540
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: