Provider Demographics
NPI:1497794945
Name:MOODY, MARCUS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:
Last Name:MOODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 DATA PARK
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1203
Mailing Address - Country:US
Mailing Address - Phone:205-733-9595
Mailing Address - Fax:205-733-9599
Practice Address - Street 1:2116 DATA PARK
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1203
Practice Address - Country:US
Practice Address - Phone:205-733-9595
Practice Address - Fax:205-733-9599
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27114207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL150987Medicaid
AR164511001Medicaid
ARP00398621OtherRAILROAD MEDICARE
ARI62157Medicare UPIN
AR5N831Medicare PIN
AL150987Medicaid