Provider Demographics
NPI:1649572272
Name:TODD A. MOFFATT, MD, P.A.
Entity Type:Organization
Organization Name:TODD A. MOFFATT, MD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOFFATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-744-7881
Mailing Address - Street 1:PO BOX 21925
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-1925
Mailing Address - Country:US
Mailing Address - Phone:254-744-7881
Mailing Address - Fax:
Practice Address - Street 1:1000 W HIGHWAY 6
Practice Address - Street 2:SUITE 400
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3786
Practice Address - Country:US
Practice Address - Phone:254-744-7881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2894208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty