Provider Demographics
NPI:1760428825
Name:MOY, RAYMOND WUI (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:WUI
Last Name:MOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAYMOND
Other - Middle Name:WUI
Other - Last Name:MOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6917 W OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2973
Mailing Address - Country:US
Mailing Address - Phone:414-545-7245
Mailing Address - Fax:414-545-3373
Practice Address - Street 1:6917 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-2973
Practice Address - Country:US
Practice Address - Phone:414-545-7245
Practice Address - Fax:414-545-3373
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21142207Q00000X, 2084A0401X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30254700Medicaid
WI21335000Medicaid
WI1760428825OtherMEDICARE NPI INDUVIDUAL
WI1740469873OtherMEDICARE NPI GROUP
WIB55241Medicare UPIN
WI000001451Medicare PIN
WI000101451Medicare PIN