Provider Demographics
NPI:1578808325
Name:REBECCA A MOUL, DO PC
Entity Type:Organization
Organization Name:REBECCA A MOUL, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOUL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-587-3480
Mailing Address - Street 1:2815 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3216
Mailing Address - Country:US
Mailing Address - Phone:423-587-3480
Mailing Address - Fax:423-586-7271
Practice Address - Street 1:2815 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3216
Practice Address - Country:US
Practice Address - Phone:423-587-3480
Practice Address - Fax:423-586-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2440207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty