Provider Demographics
NPI:1942512751
Name:MOFFAT, ANDREW DAVIS (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DAVIS
Last Name:MOFFAT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3590 W 9000 S
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8857
Mailing Address - Country:US
Mailing Address - Phone:801-601-2322
Mailing Address - Fax:801-601-2679
Practice Address - Street 1:3590 W 9000 S
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8857
Practice Address - Country:US
Practice Address - Phone:801-601-2322
Practice Address - Fax:801-601-2679
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2014-07-30
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Provider Licenses
StateLicense IDTaxonomies
UT86093511204207Q00000X
UT86093518904207Q00000X
UT8609351-12042083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine