Healthcare Provider Details

I. General information

NPI: 1346297785
Provider Name (Legal Business Name): RICHARD ALLEN MOYER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S COURT ST
LAPEER MI
48446-2514
US

IV. Provider business mailing address

4466 W BRISTOL RD
FLINT MI
48507-3170
US

V. Phone/Fax

Practice location:
  • Phone: 810-667-6110
  • Fax: 810-667-3562
Mailing address:
  • Phone: 810-733-1200
  • Fax: 810-733-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101010355
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: