MEDICARE: DAVID MICHAEL MOINESTER D.P.M.

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	213ES0131X	Foot Surgery Podiatrist	DPM 194	TN

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

General Provider Information

NPI Number	:	1386639789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MICHAEL MOINESTER D.P.M.

Provider Business Mailing Address
First Line	:	1068 CRESTHAVEN RD STE 300
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-0809
Country	:	US
Telephone Number	:	901-866-8864
Fax Number	:

Provider Business Practice Location Address
First Line	:	1068 CRESTHAVEN RD STE 110
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-0845
Country	:	US
Telephone Number	:	901-767-5620
Fax Number	:	901-763-4326

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	02/25/2025

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