Provider Demographics
NPI:1760474787
Name:DE MOYA, JORGE OSCAR JR (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:OSCAR
Last Name:DE MOYA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 CORAL WAY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2305
Mailing Address - Country:US
Mailing Address - Phone:305-265-9686
Mailing Address - Fax:305-269-7933
Practice Address - Street 1:8415 CORAL WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2305
Practice Address - Country:US
Practice Address - Phone:305-265-9686
Practice Address - Fax:305-269-7933
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064332700Medicaid
FL11259AMedicare ID - Type Unspecified
FL064332700Medicaid