Healthcare Provider Details

I. General information

NPI: 1174167746
Provider Name (Legal Business Name): MOYER MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E TROPICANA AVE STE 163
LAS VEGAS NV
89119-6516
US

IV. Provider business mailing address

11459 OPAL SPRINGS WAY
LAS VEGAS NV
89135-3421
US

V. Phone/Fax

Practice location:
  • Phone: 702-856-6838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA MOYER
Title or Position: NURSE PRACTITIONER
Credential: APRN-BC
Phone: 702-856-6838