Provider Demographics
NPI:1710922174
Name:PHIL MOYER MD PLLC
Entity Type:Organization
Organization Name:PHIL MOYER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-255-9797
Mailing Address - Street 1:2120 W ELK AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1500
Mailing Address - Country:US
Mailing Address - Phone:580-255-9797
Mailing Address - Fax:580-255-9826
Practice Address - Street 1:2120 W ELK AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1500
Practice Address - Country:US
Practice Address - Phone:580-255-9797
Practice Address - Fax:580-255-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22001208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty