Individual
PHILIP MOUDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3495 BAILEY AVE, BUFFALO, NY 14215-1129
(716) 862-6015
Mailing address
3495 BAILEY AVE, BUFFALO, NY 14215-1129
(716) 862-6015
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
126843-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00820306
—
NY
Enumeration date
02/28/2006
Last updated
07/08/2007
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