Provider Demographics
NPI:1528044658
Name:MOXON, DARRAN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:DARRAN
Middle Name:RICHARD
Last Name:MOXON
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:PO BOX 7630
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-7002
Mailing Address - Country:US
Mailing Address - Phone:630-208-7388
Mailing Address - Fax:630-208-4818
Practice Address - Street 1:2455 DEAN ST STE A&B
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-4830
Practice Address - Country:US
Practice Address - Phone:630-208-7388
Practice Address - Fax:630-208-4818
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096944207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H61259Medicare UPIN
H61259Medicare UPIN