Healthcare Provider Details

I. General information

NPI: 1164691937
Provider Name (Legal Business Name): DOUGLAS MATTHEW MOECKEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 07/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E CHEVES ST SUITE 370
FLORENCE SC
29506-2716
US

IV. Provider business mailing address

901 E CHEVES ST SUITE 370
FLORENCE SC
29506-2716
US

V. Phone/Fax

Practice location:
  • Phone: 843-667-6229
  • Fax:
Mailing address:
  • Phone: 843-667-6229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAS3835571-2007017363
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD35496
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: