Provider Demographics
NPI:1700831971
Name:MOY, RICHARD R (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:MOY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:29300 PORTOLA PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8718
Mailing Address - Country:US
Mailing Address - Phone:949-837-3338
Mailing Address - Fax:949-716-2725
Practice Address - Street 1:29300 PORTOLA PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8718
Practice Address - Country:US
Practice Address - Phone:949-837-3338
Practice Address - Fax:949-716-2725
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3833213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3833AMedicare ID - Type Unspecified
CAU32547Medicare UPIN