Provider Demographics
NPI:1740447234
Name:RICHARD A MOYER DO PC
Entity type:Organization
Organization Name:RICHARD A MOYER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-664-3984
Mailing Address - Street 1:1257 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446
Mailing Address - Country:US
Mailing Address - Phone:810-664-3984
Mailing Address - Fax:810-664-2125
Practice Address - Street 1:1257 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1348
Practice Address - Country:US
Practice Address - Phone:810-664-3984
Practice Address - Fax:810-664-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010355207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4670432OtherAETNA INSURANCE
MI5440033OtherMEDICARE PLUS BLUE
0653890004OtherCIGNA INSURANCE
1000676OtherMCLAREN HEALTH PLAN
5440033OtherBLUE CROSS BLUE SHIELD OF MICHINGA
MI5440033OtherBSBSM MEDICARE ADVANTAGE
MI114210759Medicaid
113342OtherGREAT LAKES HEALTH PLAN
1000676OtherMCLAREN HEALTH PLAN
113342OtherGREAT LAKES HEALTH PLAN