Healthcare Provider Details

I. General information

NPI: 1992985014
Provider Name (Legal Business Name): ROY R. MOELLER D.P.M. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 DELL RD STE 140
CHANHASSEN MN
55317-9314
US

IV. Provider business mailing address

7770 DELL RD STE 140
CHANHASSEN MN
55317-9314
US

V. Phone/Fax

Practice location:
  • Phone: 952-934-9360
  • Fax: 952-975-0118
Mailing address:
  • Phone: 952-934-9360
  • Fax: 952-975-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number396
License Number StateMN

VIII. Authorized Official

Name: DAVID A BRANDELL
Title or Position: ATTORNEY FOR CORPORATION
Credential:
Phone: 952-944-8344