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General NPI Number Information
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NPI Number | 1700042215
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Entity Type | Individual
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Provider Name | CHAD D MOORMAN DPM
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Gender | Male
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 655 W 8TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 904-244-5343
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Fax | 904-244-2358
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Provider Business Mailing Address
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Address Line | PO BOX 44008
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City | JACKSONVILLE
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State | FL
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Zip | 32231-4008
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Country | US
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Telephone | 904-244-3566
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Fax | 904-244-9540
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0103301126
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO4610
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License Number State | FL
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