Provider Demographics
NPI:1427046937
Name:MOATS, CAROLYN C (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:C
Last Name:MOATS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20199 N 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8807
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:
Practice Address - Street 1:13737 N 92ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7434
Practice Address - Country:US
Practice Address - Phone:480-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074827207Q00000X
AZ40745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI432057284OtherUNITED HEALTHCARE
MI4678167Medicaid
AZP00625156OtherRAILROAD MEDICARE
MI432057284OtherPRIORITY HEALTH
MI0281048OtherBCBS
MICJ9618OtherRAILROAD MEDICARE
AZ365182Medicaid
MI432057284OtherPRIORITY HEALTH
MIH27419Medicare UPIN
MIP04070001Medicare PIN