Provider Demographics
NPI:1841643764
Name:MOFFAT, CHASE (DPM)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:MOFFAT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9058
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85214-9058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:480-564-4904
Practice Address - Street 1:2919 S ELLSWORTH RD STE 124
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2167
Practice Address - Country:US
Practice Address - Phone:480-633-7944
Practice Address - Fax:480-633-0255
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006756213E00000X
AZPOD-001022213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist