Provider Demographics
NPI:1174198741
Name:MOFFITT, CLAIRE SUZANNE
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:SUZANNE
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:SUZANNE
Other - Last Name:MOFFITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:501 EL CORTO ST
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2805
Mailing Address - Country:US
Mailing Address - Phone:620-855-0560
Mailing Address - Fax:
Practice Address - Street 1:200 W ROSS BLVD
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-7221
Practice Address - Country:US
Practice Address - Phone:620-371-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant