Provider Demographics
NPI:1548417843
Name:MOFFATT, CAMERON WAYNE (IDC)
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:WAYNE
Last Name:MOFFATT
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS FORREST SHERMAN
Mailing Address - Street 2:UNIT 23149
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09569-1214
Mailing Address - Country:US
Mailing Address - Phone:757-444-4541
Mailing Address - Fax:
Practice Address - Street 1:USS FORREST SHERMAN
Practice Address - Street 2:UNIT 23149
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09569-1214
Practice Address - Country:US
Practice Address - Phone:757-444-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman