Healthcare Provider Details

I. General information

NPI: 1457396814
Provider Name (Legal Business Name): PHILIP MOYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 02/09/2022
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 US HIGHWAY 441 N STE H
OKEECHOBEE FL
34972-1900
US

IV. Provider business mailing address

1713 US HIGHWAY 441 N STE H
OKEECHOBEE FL
34972-1900
US

V. Phone/Fax

Practice location:
  • Phone: 863-357-1510
  • Fax: 863-357-1518
Mailing address:
  • Phone: 863-357-1510
  • Fax: 863-357-1518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME 102679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: