Healthcare Provider Details

I. General information

NPI: 1457616922
Provider Name (Legal Business Name): ALEXANDER MOYA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S RIDGEWOOD AVE SUITE #2
EDGEWATER FL
32132-1946
US

IV. Provider business mailing address

201 S RIDGEWOOD AVE SUITE #2
EDGEWATER FL
32132-1946
US

V. Phone/Fax

Practice location:
  • Phone: 386-423-9573
  • Fax: 386-423-6823
Mailing address:
  • Phone: 386-423-9573
  • Fax: 386-423-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: