Healthcare Provider Details

I. General information

NPI: 1679766133
Provider Name (Legal Business Name): KYLE JOSEPH MOYLES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2007
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W EAU GALLIE BLVD SUITE E
MELBOURNE FL
32935-5300
US

IV. Provider business mailing address

1310 W EAU GALLIE BLVD SUITE E
MELBOURNE FL
32935-5300
US

V. Phone/Fax

Practice location:
  • Phone: 321-500-4263
  • Fax: 888-782-9622
Mailing address:
  • Phone: 321-500-4263
  • Fax: 888-782-9622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME113873
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME113873
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: