Provider Demographics
NPI:1588666036
Name:MOFFETT, STEVEN RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RAY
Last Name:MOFFETT
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:7557 DANNAHER WAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3558
Mailing Address - Country:US
Mailing Address - Phone:865-673-9250
Mailing Address - Fax:865-859-7368
Practice Address - Street 1:7557 DANNAHER WAY
Practice Address - Street 2:SUITE 140
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3558
Practice Address - Country:US
Practice Address - Phone:865-673-9250
Practice Address - Fax:865-859-7368
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2011-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000012333207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4280579OtherBCBST
TNB04577Medicare UPIN
TN4280579OtherBCBST