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General NPI Number Information
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NPI Number | 1710125000
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Entity Type | Organization
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Legal Business Name | JEFFREY L MOFFAT MD PLLC
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 01/26/2009
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Provider Practice Location Address
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Address Line | 5448 S WHITE MOUNTAIN ROAD SUITE 270
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City | LAKESIDE
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State | AZ
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Zip | 85929
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Country | US
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Telephone | 928-532-5838
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Fax | 928-532-6670
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | OVERGAARD
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State | AZ
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Zip | 85933-0010
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Country | US
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Telephone | 928-535-6667
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Fax | 928-535-5561
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY L MOFFAT
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Credential | MD
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Telephone | 928-537-2480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36459
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License Number State | AZ
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