Provider Demographics
NPI:1720071061
Name:MOFFETT, EUGENE VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:VICTOR
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 1:185 E 7TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3356
Mailing Address - Country:US
Mailing Address - Phone:530-343-0200
Mailing Address - Fax:530-345-1881
Practice Address - Street 1:185 E 7TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3356
Practice Address - Country:US
Practice Address - Phone:530-343-0200
Practice Address - Fax:530-345-1881
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28408207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G284080Medicaid
CA00G284080Medicaid
CAA89463Medicare UPIN