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General NPI Number Information
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NPI Number | 1376544577
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Entity Type | Individual
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Provider Name | KARL E.T. MOON MD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 10815 W. MCDOWELL RD. STE 202
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City | AVONDALE
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State | AZ
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Zip | 85392-5007
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Country | US
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Telephone | 623-433-0202
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Fax | 623-433-0204
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Provider Business Mailing Address
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Address Line | 9250 N 3RD ST STE 4010
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City | PHOENIX
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State | AZ
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Zip | 85020-2437
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Country | US
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Telephone | 602-633-3848
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Fax | 602-633-3841
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25645
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License Number State | AZ
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