Provider Demographics
NPI:1780224873
Name:RICHARD R MOY, D.P.M., INC
Entity Type:Organization
Organization Name:RICHARD R MOY, D.P.M., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/ FOOT & ANKLE SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-837-3338
Mailing Address - Street 1:29300 PORTOLA PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8741
Mailing Address - Country:US
Mailing Address - Phone:949-837-3338
Mailing Address - Fax:
Practice Address - Street 1:29300 PORTOLA PKWY STE B
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8741
Practice Address - Country:US
Practice Address - Phone:949-837-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty