MEDICARE: DR. ANDREW DAVIS MOFFAT D.O.

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	207Q00000X	Family Medicine Physician	86093511204	UT
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	86093511204	UT
3	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	8609351-1204	UT

General Provider Information

NPI Number	:	1942512751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW DAVIS MOFFAT D.O.

Provider Business Mailing Address
First Line	:	3590 W 9000 S
Second Line	:	SUITE 105
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-8857
Country	:	US
Telephone Number	:	801-601-2322
Fax Number	:	801-601-2679

Provider Business Practice Location Address
First Line	:	2132 N ROBINS DR STE 100
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-7059
Country	:	US
Telephone Number	:	801-807-7900
Fax Number	:	801-807-7904

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

Provider Enumeration Date	:	07/09/2010
Last Update Date	:	04/04/2025

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