Provider Demographics
NPI:1902817869
Name:MOFFETT, TYLER CAPHTON (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:CAPHTON
Last Name:MOFFETT
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 1:37578 CAPTAINS COURT CIR
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-8794
Mailing Address - Country:US
Mailing Address - Phone:907-395-0443
Mailing Address - Fax:
Practice Address - Street 1:1201 N MULDOON RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-6104
Practice Address - Country:US
Practice Address - Phone:907-257-4700
Practice Address - Fax:907-580-2090
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMEDS3968208M00000X
AK3968207R00000X, 207RP1001X
WAMD32612207R00000X, 207RP1001X
IDM6420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease