MEDICARE: RONALD PETER MOYER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	17297	KY

General Provider Information

NPI Number	:	1164414488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD PETER MOYER MD

Provider Business Mailing Address
First Line	:	4402 CHURCHMAN AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-3102
Country	:	US
Telephone Number	:	502-361-9935
Fax Number	:	502-361-9950

Provider Business Practice Location Address
First Line	:	4402 CHURCHMAN AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-1190
Country	:	US
Telephone Number	:	502-361-9935
Fax Number	:	502-361-9950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/08/2007

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