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General NPI Number Information
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NPI Number | 1083677793
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Entity Type | Individual
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Provider Name | SUZELLE L MOFFITT MD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 121 EL PASO RD
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City | RUIDOSO
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State | NM
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Zip | 88345-6033
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Country | US
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Telephone | 575-630-8350
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Fax | 575-257-4055
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Provider Business Mailing Address
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Address Line | 575 HILL COUNTRY DR STE 101
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City | KERRVILLE
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State | TX
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Zip | 78028-6024
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Country | US
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Telephone | 830-258-7090
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Fax | 830-258-7098
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H5566
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2017-0489
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License Number State | NM
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