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Individual
DR. KENNETH P MOFFAT
Active
Individual
DR. KENNETH P MOFFAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
28160
KY
207W00000X
Ophthalmology Physician
MD0000021088
TN
207WX0107X
Retina Specialist (Ophthalmology) Physician
28160
KY
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
MD0000021088
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00554
MEDICARE/GROUP
KY
01
—
3379053
MEDICARE/GROUP
TN
05
—
64798374
—
KY
Enumeration date
10/14/2005
Last updated
08/04/2017
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