Provider Demographics
NPI:1376544577
Name:MOON, KARL ET (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:ET
Last Name:MOON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9250 N 3RD ST
Mailing Address - Street 2:STE 4010
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2437
Mailing Address - Country:US
Mailing Address - Phone:602-633-3848
Mailing Address - Fax:602-633-3841
Practice Address - Street 1:10815 W. MCDOWELL RD.
Practice Address - Street 2:STE 202
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5007
Practice Address - Country:US
Practice Address - Phone:623-433-0202
Practice Address - Fax:623-433-0204
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-10-09
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Provider Licenses
StateLicense IDTaxonomies
AZ25645207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ394734Medicaid
AZZ128900Medicare PIN