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General NPI Number Information
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NPI Number | 1043369747
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Entity Type | Individual
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Provider Name | PATRICIA L. MOODY MD
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/09/2015
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Provider Practice Location Address
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Address Line | 2780 MCFARLAND RD
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City | ROCKFORD
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State | IL
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Zip | 61107-6807
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Country | US
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Telephone | 815-971-2000
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Fax | 815-637-0400
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Provider Business Mailing Address
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Address Line | 2780 MCFARLAND RD
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City | ROCKFORD
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State | IL
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Zip | 61107-6807
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Country | US
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Telephone | 815-971-2000
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Fax | 815-637-0400
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036103063
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License Number State | IL
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