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General NPI Number Information
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NPI Number | 1104080019
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Entity Type | Organization
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Legal Business Name | MICHAEL MOYER MD PA
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 3592 ALOMA AVE SUITE 5
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City | WINTER PARK
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State | FL
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Zip | 32792-4012
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Country | US
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Telephone | 407-671-7141
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Fax | 407-671-7104
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Provider Business Mailing Address
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Address Line | PO BOX 721239
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City | ORLANDO
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State | FL
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Zip | 32872-1239
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Country | US
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Telephone | 407-671-7141
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Fax | 407-671-7104
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL MOYER
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Credential | MD
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Telephone | 407-671-7141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME61609
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License Number State | FL
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