Healthcare Provider Details

I. General information

NPI: 1821158734
Provider Name (Legal Business Name): ROBIN NELSON MOYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E KING ST
CHEWELAH WA
99109-0137
US

IV. Provider business mailing address

PO BOX 137
CHEWELAH WA
99109-0137
US

V. Phone/Fax

Practice location:
  • Phone: 509-935-8711
  • Fax: 509-935-4882
Mailing address:
  • Phone: 509-935-8711
  • Fax: 509-935-4882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00024591
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: