Provider Demographics
NPI:1851416085
Name:MOFFITT, MELINDA J (PA C)
Entity type:Individual
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First Name:MELINDA
Middle Name:J
Last Name:MOFFITT
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Gender:F
Credentials:PA C
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Mailing Address - Street 1:MSC06 3870 I UNIV OF NM
Mailing Address - Street 2:UMN STUDENT HEALTH CENTER
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-277-3136
Mailing Address - Fax:505-277-5668
Practice Address - Street 1:MSC06 3870 I UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:UMN STUDENT HEALTH CENTER
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-277-3136
Practice Address - Fax:505-277-5668
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NM79PA006363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant