Healthcare Provider Details

I. General information

NPI: 1760460943
Provider Name (Legal Business Name): ROBERT D MOYLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BRAEBURN DR VALLEY GASTROENTEROLOGY OF SW VA
SALEM VA
24153
US

IV. Provider business mailing address

1906 BRAEBURN DR. VALLEY GASTROENTEROLOGY OF SOUTHWEST VA PC
SALEM VA
24153
US

V. Phone/Fax

Practice location:
  • Phone: 540-776-6300
  • Fax: 540-776-1103
Mailing address:
  • Phone: 540-776-6300
  • Fax: 540-776-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101043742
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: