MEDICARE: BRIANT G. MOYLES D.P.M., P.A.

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	213E00000X	Podiatrist		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	72224	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1194998286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIANT G. MOYLES D.P.M., P.A.

Provider Business Mailing Address
First Line	:	1515 DR MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-2946
Country	:	US
Telephone Number	:	321-723-3500
Fax Number	:	321-723-1945

Provider Business Practice Location Address
First Line	:	1310 W EAU GALLIE BLVD
Second Line	:	SUITE E
City	:	MELBOURNE
State	:	FL
Zip	:	32935-5300
Country	:	US
Telephone Number	:	321-255-3338
Fax Number	:	321-253-9643

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD C WILSON
Credential	:	D.P.M., P.A.
Telephone Number	:	321-255-3338

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	02/23/2023

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