Doctor Name: | DR. MICHAEL N MOODY |
NPI Number: | 1063489821 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | C-4622 |
Business Practice Address: | 507 N Main St Salem, AR - 725769449 |
Business Phone Number: | 8708952541 |
Business Fax Number: | 8708952957 |
Mailing Address: | Po Box 829, SALEM |
State: | AR |
Postal Code: | 725760829 |
Phone Number: | 8708952541 |
Fax Number: | 8708952957 |
NPI Enumeration Date: | 03/01/2006 |
NPI Last Update Date: | 12/22/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | C-4622 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |