Individual
MR. MARK MOFFA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1903 COUNTY ROAD D W, ARDEN HILLS, MN 55112-3512
(612) 701-9549
Mailing address
1903 COUNTY ROAD D., ARDEN HILLS, MN 55112
(612) 701-9549
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MARK1961
PROSTHETICS
MN
Enumeration date
05/19/2009
Last updated
05/19/2009
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