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General NPI Number Information
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NPI Number | 1518222132
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Entity Type | Organization
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Legal Business Name | MOOSE HAND CENTER, PLLC
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 10502 PARK RD SUITE 170
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City | CHARLOTTE
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State | NC
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Zip | 28210-8479
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Country | US
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Telephone | 704-372-0527
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Fax | 704-372-7564
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Provider Business Mailing Address
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Address Line | 10502 PARK RD SUITE 170
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City | CHARLOTTE
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State | NC
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Zip | 28210-8479
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Country | US
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Telephone | 704-372-0527
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Fax | 704-372-7564
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. DURMAN WILLIAM MOOSE JR.
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Credential | M.D.
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Telephone | 704-372-0527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) Physician
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License Number | 32543
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License Number State | NC
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