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General NPI Number Information
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NPI Number | 1700106549
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Entity Type | Organization
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Legal Business Name | SHIROLYN MOFFETT M.D.,P.A.
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 715 W SHERMAN AVE SUITE D
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City | HARRISON
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State | AR
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Zip | 72601-2743
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Country | US
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Telephone | 870-204-5129
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Fax | 870-204-5131
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Provider Business Mailing Address
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Address Line | 715 W SHERMAN AVE SUITE D
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City | HARRISON
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State | AR
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Zip | 72601-2743
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Country | US
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Telephone | 870-204-5129
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Fax | 870-204-5131
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHIROLYN RUTH MOFFETT
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Credential | M.D.
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Telephone | 870-204-5129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | E0693
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License Number State | AR
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