Provider Demographics
NPI:1225027378
Name:MOELLER, ROY ROGER (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:ROGER
Last Name:MOELLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7770 DELL ROAD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317
Mailing Address - Country:US
Mailing Address - Phone:952-934-9360
Mailing Address - Fax:952-975-0118
Practice Address - Street 1:7770 DELL ROAD
Practice Address - Street 2:SUITE 140
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317
Practice Address - Country:US
Practice Address - Phone:952-934-9360
Practice Address - Fax:952-975-0118
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN396213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN203525100Medicaid
AM3251472OtherDEA
MN480000112Medicare PIN
AM3251472OtherDEA