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General NPI Number Information
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NPI Number | 1770845992
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Entity Type | Individual
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Provider Name | CATHERINE C MOFFITT DO
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Gender | Female
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 10101 ERNST RD STE 1200
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City | ROANOKE
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State | IN
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Zip | 46783-9711
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Country | US
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Telephone | 260-234-5400
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Fax | 260-234-5410
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Provider Business Mailing Address
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Address Line | 14419 SMUGGLERS NOTCH
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City | FORT WAYNE
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State | IN
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Zip | 46814-8701
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Country | US
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Telephone | 260-402-3139
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02004346A
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License Number State | IN
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