Healthcare Provider Details

I. General information

NPI: 1346290640
Provider Name (Legal Business Name): NATHAN WEILAN MOY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 71ST ST SUITE 101
MIAMI BEACH FL
33141-2972
US

IV. Provider business mailing address

2823 SW 125TH AVE
MIRAMAR FL
33027-4116
US

V. Phone/Fax

Practice location:
  • Phone: 305-866-6665
  • Fax:
Mailing address:
  • Phone: 240-678-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number213EG0000X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: