MEDICARE: DR. ALFRED H MOFFETT JR. M.D.

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	ME0016264	FL

General Provider Information

NPI Number	:	1952384380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFRED H MOFFETT JR. M.D.

Provider Business Mailing Address
First Line	:	601 E DIXIE AVE
Second Line	:	MEDICAL PLAZA #401
City	:	LEESBURG
State	:	FL
Zip	:	34748-5953
Country	:	US
Telephone Number	:	352-787-1535
Fax Number	:	352-787-5310

Provider Business Practice Location Address
First Line	:	601 E DIXIE AVE
Second Line	:	MEDICAL PLAZA #401
City	:	LEESBURG
State	:	FL
Zip	:	34748-5953
Country	:	US
Telephone Number	:	352-787-1535
Fax Number	:	352-787-5310

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	06/14/2010

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