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NPI Code Detail

MEDICARE: PHILIP MOODEY MD

MEDICARE: PHILIP MOODEY MD
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
1207Q00000XFamily Medicine PhysicianMD.MD.70066511WA

General Provider Information

NPI Number : 1487357299
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILIP MOODEY MD
Provider Business Mailing Address
First Line : 799 BLOOMFIELD AVE STE 201
Second Line :
City : VERONA
State : NJ
Zip : 07044-1374
Country : US
Telephone Number : 973-746-7050
Fax Number :
Provider Business Practice Location Address
First Line : 16811 SE MCGILLIVRAY BLVD
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-3404
Country : US
Telephone Number : 360-735-8100
Fax Number : 360-253-1781
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2023
Last Update Date : 06/10/2026

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Directions to “ PHILIP MOODEY MD” Practice Location

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