Provider Demographics
NPI:1083675367
Name:MOFFATT, WILLIAM LEE III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LEE
Last Name:MOFFATT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:STE 309
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119
Mailing Address - Country:US
Mailing Address - Phone:901-682-5642
Mailing Address - Fax:901-683-5527
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:STE 309
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-682-5642
Practice Address - Fax:901-683-5527
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD8529207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA200027315OtherRAILROAD MEDICARE
TN0928140001Medicare NSC
GA200027315OtherRAILROAD MEDICARE
TN3174271Medicare ID - Type Unspecified