Provider Demographics
NPI:1629097126
Name:MOYER, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MOYER
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 1:89 SYLVANIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3281
Mailing Address - Country:US
Mailing Address - Phone:937-320-2020
Mailing Address - Fax:937-320-0504
Practice Address - Street 1:89 SYLVANIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3281
Practice Address - Country:US
Practice Address - Phone:937-320-2020
Practice Address - Fax:937-320-0504
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071016174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000221360OtherANTHEM
OHP00023711OtherMEDICARE RAILROAD
OH1629097126OtherNPI
OH2109015Medicaid
OH0801867OtherUNITED HEALTHCARE
OH1629097126OtherNPI
OH0321780001Medicare NSC
OH2109015Medicaid
OH0872947Medicare PIN
0872948Medicare PIN