MEDICARE: MARK JAMES MOODY 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
1	207R00000X	Internal Medicine Physician	G38627	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1962422618	OTHER	CA	NPI
2	G38627	OTHER	CA	MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952588592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JAMES MOODY MD

Provider Business Mailing Address
First Line	:	5900 COYLE AVE
Second Line	:	SUITE A
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-0400
Country	:	US
Telephone Number	:	916-344-9400
Fax Number	:	916-344-9401

Provider Business Practice Location Address
First Line	:	5900 COYLE AVE
Second Line	:	SUITE A
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-0400
Country	:	US
Telephone Number	:	916-344-9400
Fax Number	:	916-344-9401

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

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	02/14/2011

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