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Individual

JOSEPH C MOODY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01052363
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000586076
ANTHEM PROVIDER NUMBER
IN
05
200295790
IN
Enumeration date
08/27/2006
Last updated
10/01/2009
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