Provider Demographics
NPI:1164691937
Name:MOECKEL, DOUGLAS MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MATTHEW
Last Name:MOECKEL
Suffix:
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 1:901 E CHEVES ST
Mailing Address - Street 2:SUITE 370
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2716
Mailing Address - Country:US
Mailing Address - Phone:843-667-6229
Mailing Address - Fax:
Practice Address - Street 1:901 E CHEVES ST
Practice Address - Street 2:SUITE 370
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2716
Practice Address - Country:US
Practice Address - Phone:843-667-6229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2013-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOAS3835571-2007017363208000000X
SCMD354962080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics