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General NPI Number Information
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NPI Number | 1609988112
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Entity Type | Individual
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Provider Name | VICTOR DE MOYA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 403A HOLLYWOOD BLVD,, NW SUITE 104
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4531
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Country | US
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Telephone | 850-244-0101
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Fax | 850-243-9795
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Provider Business Mailing Address
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Address Line | 403A HOLLYWOOD BLVD,, NW SUITE 104
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4531
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Country | US
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Telephone | 850-244-0101
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Fax | 850-243-9795
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 53869
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License Number State | FL
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