Provider Demographics
NPI:1629183306
Name:MOY, ALAN D (DO)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:D
Last Name:MOY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6300 LA CALMA DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752
Mailing Address - Country:US
Mailing Address - Phone:310-488-0669
Mailing Address - Fax:
Practice Address - Street 1:551 HILL COUNTRY DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6085
Practice Address - Country:US
Practice Address - Phone:310-488-0669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7786207P00000X
GA058990207P00000X
MT11330207P00000X
TXP3937207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH30654Medicare UPIN