Healthcare Provider Details

I. General information

NPI: 1760428825
Provider Name (Legal Business Name): RAYMOND WUI MOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAYMOND WUI MOY M.D.

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 W OKLAHOMA AVE
MILWAUKEE WI
53219-2973
US

IV. Provider business mailing address

6917 W OKLAHOMA AVE
MILWAUKEE WI
53219-2973
US

V. Phone/Fax

Practice location:
  • Phone: 414-545-7245
  • Fax: 414-545-3373
Mailing address:
  • Phone: 414-545-7245
  • Fax: 414-545-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21142
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number21142
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21142
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: