Provider Demographics
NPI:1780639591
Name:MORETZ, RICHARD EMIL (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EMIL
Last Name:MORETZ
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 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6174
Mailing Address - Fax:
Practice Address - Street 1:333 S PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2622
Practice Address - Country:US
Practice Address - Phone:864-591-1664
Practice Address - Fax:864-577-0620
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9068208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576007863153OtherBCBS OF SC
SC90680Medicaid
SCP00676412OtherRR MEDICARE
SC576007863153OtherBCBS OF SC
SCB922997951Medicare PIN
SCB922993640Medicare PIN