Provider Demographics
NPI:1457396814
Name:MOYER, PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
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 1:1713 US HIGHWAY 441 N
Mailing Address - Street 2:STE H
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1900
Mailing Address - Country:US
Mailing Address - Phone:863-357-1510
Mailing Address - Fax:863-357-1518
Practice Address - Street 1:1713 US HIGHWAY 441 N
Practice Address - Street 2:STE H
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1900
Practice Address - Country:US
Practice Address - Phone:863-357-1510
Practice Address - Fax:863-357-1518
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 102679208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91850OtherFLORIDA BLUE
FL000620400Medicaid
FLBO849ZMedicare PIN