Basic Information
| Provider Information | |||||||||
| NPI: | 1124033709 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOFFATT | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 E ARIZONA BILTMORE CIR STE D142 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850162147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023850430 | ||||||||
| FaxNumber: | 6022560795 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 E ARIZONA BILTMORE CIR STE D142 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023850430 | ||||||||
| FaxNumber: | 6022560795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 07/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 47834 | AZ | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | ME91980 | FL | N | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.