Healthcare Provider Details

I. General information

NPI: 1114035466
Provider Name (Legal Business Name): DR. JOSEPH G MOYSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSEPH G MOYSE MD

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 03/09/2025
Certification Date: 03/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 LAKE TRAFFORD RD
IMMOKALEE FL
34142-2618
US

IV. Provider business mailing address

3155 LAKE WORTH RD STE 1
PALM SPRINGS FL
33461-6917
US

V. Phone/Fax

Practice location:
  • Phone: 239-900-9170
  • Fax: 561-878-8277
Mailing address:
  • Phone: 561-858-8817
  • Fax: 561-878-8277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number15224
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberACN252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: