Healthcare Provider Details

I. General information

NPI: 1942632856
Provider Name (Legal Business Name): JEFFREY MOY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 10/01/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6145 N THESTA ST
FRESNO CA
93710-5266
US

IV. Provider business mailing address

6145 N THESTA ST
FRESNO CA
93710-5266
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-4820
  • Fax:
Mailing address:
  • Phone: 559-436-4820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number3841
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: