Provider Demographics
NPI:1578644373
Name:DEMOYA, JOSE F (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:F
Last Name:DEMOYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0623
Mailing Address - Country:US
Mailing Address - Phone:434-584-5436
Mailing Address - Fax:434-845-4955
Practice Address - Street 1:1755 N MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-4080
Practice Address - Country:US
Practice Address - Phone:434-584-5436
Practice Address - Fax:434-584-5495
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-53184208600000X
VA0101053710208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADE8368OtherRR MEDICARE
VA6344131OtherCIGNA
VA1578644373Medicaid
NC890632PMedicaid
FL257234600Medicaid
VA348505OtherANTHEM BCBS
VA784825OtherSOUTHERN HEALTH
FL09814Medicare ID - Type Unspecified
FL257234600Medicaid
VAP00768180Medicare PIN
FLD82717Medicare UPIN
VAC09818Medicare PIN