Healthcare Provider Details

I. General information

NPI: 1992989487
Provider Name (Legal Business Name): HUNTER REID MOYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 5TH ST
RAPID CITY SD
57701-7306
US

IV. Provider business mailing address

2805 5TH ST
RAPID CITY SD
57701-7306
US

V. Phone/Fax

Practice location:
  • Phone: 605-755-5700
  • Fax:
Mailing address:
  • Phone: 605-755-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number10283
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: