MEDICARE: BRIAN DAVID MOFFITT AUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	6885	NC
2	237600000X	Audiologist-Hearing Aid Fitter	6885	NC
3	231H00000X	Audiologist	6885	NC

General Provider Information

NPI Number	:	1376500413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN DAVID MOFFITT AUD

Provider Business Mailing Address
First Line	:	1915 W PARK DR STE 108
Second Line	:
City	:	N WILKESBORO
State	:	NC
Zip	:	28659-3777
Country	:	US
Telephone Number	:	336-838-7758
Fax Number	:	336-838-9790

Provider Business Practice Location Address
First Line	:	1915 W PARK DR STE 108
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-3777
Country	:	US
Telephone Number	:	336-838-7758
Fax Number	:	336-838-9790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	03/31/2021

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