Healthcare Provider Details

I. General information

NPI: 1629001714
Provider Name (Legal Business Name): DONNA R MOYER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 N MAIN ST
LAPEER MI
48446-1350
US

IV. Provider business mailing address

PO BOX 32627
DETROIT MI
48232-0627
US

V. Phone/Fax

Practice location:
  • Phone: 810-667-5500
  • Fax:
Mailing address:
  • Phone: 866-744-1452
  • Fax: 586-412-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5101010638
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: