Provider Demographics
NPI:1295197812
Name:MOYER, CODY
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:MOYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 DARROW RD
Mailing Address - Street 2:#106
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5700 DARROW RD
Practice Address - Street 2:#106
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-5026
Practice Address - Country:US
Practice Address - Phone:330-656-5911
Practice Address - Fax:330-656-5901
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.369884390200000X
OHAPRN.CNP.019660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program