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General NPI Number Information
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NPI Number | 1144275124
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Entity Type | Organization
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Legal Business Name | DPMMOFFETTNRNC LLC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1000 COLLEGE ST
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City | WILKESBORO
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State | NC
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Zip | 28697-2732
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Country | US
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Telephone | 704-438-1821
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Fax |
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Provider Business Mailing Address
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Address Line | 2017 SPRUCEWOOD ST
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City | ALBEMARLE
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State | NC
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Zip | 28001-8117
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Country | US
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Telephone | 704-438-1821
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COLIN MOFFETT
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Credential | DPM
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Telephone | 704-438-1821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 139
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License Number State | NC
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