Provider Demographics
NPI:1841202264
Name:MOYER, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:MOYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1000 LAKEVIEW RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3475
Mailing Address - Country:US
Mailing Address - Phone:727-441-9474
Mailing Address - Fax:727-449-0862
Practice Address - Street 1:1000 LAKEVIEW RD
Practice Address - Street 2:SUITE #1
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3475
Practice Address - Country:US
Practice Address - Phone:727-441-9474
Practice Address - Fax:727-449-0862
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0023784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52772Medicare ID - Type Unspecified
FLD64414Medicare UPIN