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General NPI Number Information
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NPI Number | 1881115707
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Entity Type | Individual
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Provider Name | MITCHELL CRAIG MOFFETT D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 49 TURNER ST
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City | MABEN
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State | MS
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Zip | 39750-9157
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Country | US
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Telephone | 662-397-7647
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Fax |
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Provider Business Mailing Address
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Address Line | 1665 S GREEN ST
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City | TUPELO
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State | MS
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Zip | 38804-6556
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Country | US
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Telephone | 662-377-2189
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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 | 25953
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License Number State | MS
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