Individual
STACEY EPPERSON MOFFITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
701 UNIVERSITY BLVD E STE 606, TUSCALOOSA, AL 35401-7411
(205) 752-2501
(205) 759-5874
Mailing address
701 UNIVERSITY BLVD E STE 606, TUSCALOOSA, AL 35401-7411
(205) 752-2501
(205) 759-5874
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
PA-264
AL
363AS0400X
Surgical Physician Assistant
Primary
PA.264
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051504089
—
AL
01
—
51504089
BLUE CROSS BLUE SHIELD
AL
Enumeration date
06/16/2006
Last updated
07/26/2019
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