MEDICARE: JOANNE M MOFF PA-C

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	363AS0400X	Surgical Physician Assistant	50001540	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548268238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE M MOFF PA-C

Provider Business Mailing Address
First Line	:	30 E APPLE ST
Second Line	:	STE 1480
City	:	DAYTON
State	:	OH
Zip	:	45409-2939
Country	:	US
Telephone Number	:	937-208-3220
Fax Number	:	937-208-3633

Provider Business Practice Location Address
First Line	:	30 E APPLE ST
Second Line	:	STE 1480
City	:	DAYTON
State	:	OH
Zip	:	45409-2939
Country	:	US
Telephone Number	:	937-208-3220
Fax Number	:	937-208-3633

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/17/2017

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Directions to “ JOANNE M MOFF PA-C” Practice Location

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