Provider Demographics
NPI:1790843522
Name:MOON, SAMUEL DAVID (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:DAVID
Last Name:MOON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:BOX 3834 DUMC
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-286-3232
Mailing Address - Fax:919-286-1021
Practice Address - Street 1:2200 WEST MAIN STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4640
Practice Address - Country:US
Practice Address - Phone:919-286-3232
Practice Address - Fax:919-286-1021
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC381432083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD40680Medicare UPIN
NC2222826BMedicare ID - Type Unspecified