Provider Demographics
NPI:1073557948
Name:MOYERS, GERAUD BRETT (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GERAUD
Middle Name:BRETT
Last Name:MOYERS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20335 JOSH ALLEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211
Mailing Address - Country:US
Mailing Address - Phone:276-494-6082
Mailing Address - Fax:
Practice Address - Street 1:351 COURT ST, NE
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210
Practice Address - Country:US
Practice Address - Phone:276-676-7127
Practice Address - Fax:276-676-9366
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165153367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP64014Medicare UPIN
VA430001999Medicare ID - Type Unspecified