Provider Demographics
NPI:1407803083
Name:MOFFETT, MICHAEL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MOFFETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:JOHN
Other - Last Name:MOFFETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:729 N MEDICAL CENTER DR W STE 221
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6885
Mailing Address - Country:US
Mailing Address - Phone:559-299-6600
Mailing Address - Fax:559-326-2530
Practice Address - Street 1:729 MEDICAL CENTER DRIVE WEST
Practice Address - Street 2:221
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611
Practice Address - Country:US
Practice Address - Phone:559-299-6600
Practice Address - Fax:559-326-2530
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80577207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ37565ZOtherMEDICARE ID
CAZZZ37565ZOtherMEDICARE ID