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General NPI Number Information
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NPI Number | 1275068215
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Entity Type | Organization
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Legal Business Name | BRIANT G MOYLES DPM PA
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 590 MALABAR RD SE STE 5
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City | PALM BAY
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State | FL
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Zip | 32907-3108
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Country | US
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Telephone | 321-723-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 590 MALABAR RD SE STE 5
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City | PALM BAY
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State | FL
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Zip | 32907-3108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JARED B MOYLES
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Credential | DPM
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Telephone | 321-723-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO3545
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License Number State | FL
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