Provider Demographics
NPI:1457616922
Name:MOYA, ALEXANDER (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:MOYA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 S RIDGEWOOD AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-1946
Mailing Address - Country:US
Mailing Address - Phone:386-423-9573
Mailing Address - Fax:386-423-6823
Practice Address - Street 1:201 S RIDGEWOOD AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-1946
Practice Address - Country:US
Practice Address - Phone:386-423-9573
Practice Address - Fax:386-423-6823
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3535213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHF142YMedicare PIN
HF142ZMedicare PIN