Provider Demographics
NPI:1518222132
Name:MOOSE HAND CENTER, PLLC
Entity Type:Organization
Organization Name:MOOSE HAND CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DURMAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MOOSE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:704-372-0527
Mailing Address - Street 1:10502 PARK RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8479
Mailing Address - Country:US
Mailing Address - Phone:704-372-0527
Mailing Address - Fax:704-372-7564
Practice Address - Street 1:10502 PARK RD
Practice Address - Street 2:SUITE 170
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8479
Practice Address - Country:US
Practice Address - Phone:704-372-0527
Practice Address - Fax:704-372-7564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC325432086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty