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General NPI Number Information
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NPI Number | 1053311241
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Entity Type | Individual
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Provider Name | ANTHONY C MORETTA MD
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 505 TENNESSEE ST APT 304
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City | MEMPHIS
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State | TN
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Zip | 38103-4476
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Country | US
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Telephone | 901-626-9560
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Fax |
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Provider Business Mailing Address
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Address Line | 505 TENNESSEE ST APT 304
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City | MEMPHIS
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State | TN
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Zip | 38103-4476
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Country | US
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Telephone | 901-626-9560
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 38362
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | 38362
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License Number State | TN
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