Provider Demographics
NPI:1922099910
Name:MOYER, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MOYER
Suffix:
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:PO BOX 721239
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32872-1239
Mailing Address - Country:US
Mailing Address - Phone:407-671-7141
Mailing Address - Fax:407-671-7104
Practice Address - Street 1:3592 ALOMA AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4012
Practice Address - Country:US
Practice Address - Phone:407-671-7141
Practice Address - Fax:407-671-7104
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251756600Medicaid
FL23343YMedicare PIN
E68478Medicare UPIN