Provider Demographics
NPI:1376563510
Name:SHOEMAKER-MOYLE, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:SHOEMAKER-MOYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:CE 427
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-1000
Mailing Address - Country:US
Mailing Address - Phone:573-882-7991
Mailing Address - Fax:753-884-4820
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:CE 427
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-1000
Practice Address - Country:US
Practice Address - Phone:573-882-7991
Practice Address - Fax:753-884-4820
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251686207RN0300X, 207RN0300X
MS17691207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1376563510Medicaid
VAVVB834AMedicare UPIN
MSP00662740Medicare PIN
MSP00932662Medicare PIN
MSRR 110239398OtherRAILROAD
MS512I110016Medicare PIN
MS0125736Medicaid