Healthcare Provider Details

I. General information

NPI: 1780639591
Provider Name (Legal Business Name): RICHARD EMIL MORETZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S PINE ST
SPARTANBURG SC
29302-2622
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 212
GREENVILLE SC
29615-4536
US

V. Phone/Fax

Practice location:
  • Phone: 864-591-1664
  • Fax: 864-577-0620
Mailing address:
  • Phone: 864-797-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number9068
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: