MEDICARE: MR. TERRY LEE MOYER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	ARNP9208438	FL

General Provider Information

NPI Number	:	1174526602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRY LEE MOYER CRNA

Provider Business Mailing Address
First Line	:	6053 SABAL CREEK BLVD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-7136
Country	:	US
Telephone Number	:	386-299-9866
Fax Number	:

Provider Business Practice Location Address
First Line	:	6053 SABAL CREEK BLVD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-7136
Country	:	US
Telephone Number	:	386-299-9866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	07/08/2007

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