Provider Demographics
NPI:1346290640
Name:MOY, NATHAN WEILAN (DPM)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:WEILAN
Last Name:MOY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 SW 125TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4116
Mailing Address - Country:US
Mailing Address - Phone:240-678-2331
Mailing Address - Fax:
Practice Address - Street 1:1040 71ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-2972
Practice Address - Country:US
Practice Address - Phone:305-866-6665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL213EG0000X213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4362AMedicare ID - Type Unspecified
FLV04216Medicare UPIN