Healthcare Provider Details

I. General information

NPI: 1285954461
Provider Name (Legal Business Name): JAMES EDWARD MOYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JED MOYER MD

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 DUTCHMANS LN STE 6F
LOUISVILLE KY
40207-4724
US

IV. Provider business mailing address

PO BOX 776879
CHICAGO IL
60677-6879
US

V. Phone/Fax

Practice location:
  • Phone: 502-394-5678
  • Fax: 502-394-5600
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number46268
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number164531
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46268
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: