Provider Demographics
NPI:1447257985
Name:MOFFETT, JEFFREY DEAN (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DEAN
Last Name:MOFFETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 IRA E WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3930
Mailing Address - Country:US
Mailing Address - Phone:817-481-2121
Mailing Address - Fax:817-488-4493
Practice Address - Street 1:2535 IRA E WOODS AVE
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3930
Practice Address - Country:US
Practice Address - Phone:817-481-2121
Practice Address - Fax:817-488-4493
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1398207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A6900OtherBLUE CROSS BLUE SHIELD
TX142195001Medicaid
TX8A6900OtherBLUE CROSS BLUE SHIELD
H33379Medicare UPIN