Provider Demographics
NPI:1649251786
Name:MOY, JOHN R (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:MOY
Suffix:
Gender:M
Credentials:DPM
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 570111
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32857-0111
Mailing Address - Country:US
Mailing Address - Phone:321-663-6891
Mailing Address - Fax:
Practice Address - Street 1:3936 S SEMORAN BLVD
Practice Address - Street 2:STE 323
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-4015
Practice Address - Country:US
Practice Address - Phone:321-663-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002410213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP43301Medicare PIN
FL65336Medicare PIN
NYDD4482Medicare PIN
FLU48917Medicare UPIN
FL65336Medicare ID - Type Unspecified