Provider Demographics
NPI:1659360790
Name:HIZER, MOIRA R (PA)
Entity Type:Individual
Prefix:
First Name:MOIRA
Middle Name:R
Last Name:HIZER
Suffix:
Gender:F
Credentials:PA
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 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0116
Mailing Address - Country:US
Mailing Address - Phone:256-533-7064
Mailing Address - Fax:256-704-0115
Practice Address - Street 1:201 GOVERNORS DR SW STE 400
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5183
Practice Address - Country:US
Practice Address - Phone:256-265-7246
Practice Address - Fax:256-265-7017
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.342363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891005720Medicaid
AL051517942Medicare ID - Type Unspecified
AL891005720Medicaid