Individual
DR. COLIN LEE MOFFETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
111 E 3RD AVE, GASTONIA, NC 28052-4317
(704) 874-3300
Mailing address
200 E 2ND AVE, GASTONIA, NC 28052-4358
(704) 874-1900
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
139
NC
213ES0131X
Foot Surgery Podiatrist
139
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08125
BCBS
NC
01
—
56-1384996
TAX ID
NC
05
—
8908125
—
NC
Enumeration date
05/10/2006
Last updated
05/03/2024
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