Provider Demographics
NPI:1386639789
Name:MOINESTER, DAVID MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:MOINESTER
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 1:995 S YATES RD
Mailing Address - Street 2:2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0882
Mailing Address - Country:US
Mailing Address - Phone:901-763-0461
Mailing Address - Fax:901-681-9820
Practice Address - Street 1:6575 STAGE RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3809
Practice Address - Country:US
Practice Address - Phone:901-382-0393
Practice Address - Fax:901-763-4326
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM 194213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3351646Medicaid
TN3350807Medicare PIN
TN3351646Medicaid
3350806Medicare ID - Type UnspecifiedSECOND LOCATION
T61074Medicare UPIN