Provider Demographics
NPI:1720082332
Name:MOYLE, JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MOYLE
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 1:10900 STONELAKE BLVD
Mailing Address - Street 2:STE 250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5873
Mailing Address - Country:US
Mailing Address - Phone:512-795-5100
Mailing Address - Fax:512-795-5122
Practice Address - Street 1:10900 STONELAKE BLVD
Practice Address - Street 2:STE 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5873
Practice Address - Country:US
Practice Address - Phone:512-795-5100
Practice Address - Fax:512-795-5122
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH00882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137009010Medicaid
300091561OtherRRMCARE
TX137009006Medicaid
TX137009011Medicaid
TX137009003OtherCSHCN1
TX137009004Medicaid
TX137009005OtherCSHCN2
MI1720082332Medicaid
300108426OtherRRMCARE2
TXTXB104298Medicare PIN
TXTXB104527Medicare PIN
TX82023RMedicare PIN
TX137009003OtherCSHCN1
E12288Medicare UPIN
TX137009010Medicaid
TX85090RMedicare PIN