Provider Demographics
NPI:1609984178
Name:MOFFET, ERIC DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DAVID
Last Name:MOFFET
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 1:1920 BROOKSIDE DR
Mailing Address - Street 2:SUITE 15
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660
Mailing Address - Country:US
Mailing Address - Phone:423-392-6500
Mailing Address - Fax:423-392-6504
Practice Address - Street 1:1920 BROOKSIDE DR
Practice Address - Street 2:SUITE 15
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660
Practice Address - Country:US
Practice Address - Phone:423-392-6500
Practice Address - Fax:423-392-6504
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0206202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3052859Medicaid
TN0105831OtherBCBS TN
VA069099OtherBCBS VA
TN3052850Medicare ID - Type Unspecified
TN3701225Medicare ID - Type Unspecified
TN0105831OtherBCBS TN