Healthcare Provider Details

I. General information

NPI: 1710949896
Provider Name (Legal Business Name): ANDREW MOYCE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2961 SUMMIT ST SUITE 1
OAKLAND CA
94609-3482
US

IV. Provider business mailing address

2961 SUMMIT ST SUITE 1
OAKLAND CA
94609-3482
US

V. Phone/Fax

Practice location:
  • Phone: 510-465-0941
  • Fax: 510-465-0941
Mailing address:
  • Phone: 510-465-0941
  • Fax: 510-465-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG33785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: