Provider Demographics
NPI:1376500413
Name:MOFFITT, BRIAN DAVID (AUD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:MOFFITT
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 W PARK DR STE 108
Mailing Address - Street 2:
Mailing Address - City:N WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3777
Mailing Address - Country:US
Mailing Address - Phone:336-838-7758
Mailing Address - Fax:336-838-9790
Practice Address - Street 1:1915 W PARK DR STE 108
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3777
Practice Address - Country:US
Practice Address - Phone:336-838-7758
Practice Address - Fax:336-838-9790
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6885174400000X, 237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No174400000XOther Service ProvidersSpecialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter