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General NPI Number Information
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NPI Number | 1538469465
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Entity Type | Individual
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Provider Name | DAVID MOON PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 05/21/2013
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Provider Practice Location Address
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Address Line | 9920 INDEPENDENCE PARK DR STE 100
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City | HENRICO
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State | VA
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Zip | 23233-1487
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Country | US
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Telephone | 804-285-7420
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Fax | 804-565-9053
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Provider Business Mailing Address
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Address Line | 9920 INDEPENDENCE PARK DR STE 100
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City | HENRICO
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State | VA
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Zip | 23233-1487
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Country | US
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Telephone | 804-285-7420
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110003412
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License Number State | VA
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