Provider Demographics
NPI:1245371897
Name:MOONEY, AL J III (MD)
Entity type:Individual
Prefix:DR
First Name:AL
Middle Name:J
Last Name:MOONEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALFONSO
Other - Middle Name:JOHN
Other - Last Name:MOONEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:509 MIDENHALL WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5586
Mailing Address - Country:US
Mailing Address - Phone:919-523-0569
Mailing Address - Fax:
Practice Address - Street 1:509 MIDENHALL WAY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-5586
Practice Address - Country:US
Practice Address - Phone:919-523-0569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21688207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine