Provider Demographics
NPI:1275699357
Name:MOEZZI, DAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:H
Last Name:MOEZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2474 INDIAN WELLS RD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3831
Mailing Address - Country:US
Mailing Address - Phone:505-443-0339
Mailing Address - Fax:505-434-5624
Practice Address - Street 1:2474 INDIAN WELLS RD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-3831
Practice Address - Country:US
Practice Address - Phone:505-443-0339
Practice Address - Fax:505-434-5624
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM95-302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH1455Medicaid
NMH1455Medicaid
NM500521034Medicare ID - Type Unspecified