Provider Demographics
NPI:1811167125
Name:MOYER, PETER MICHAEL (DPM)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:MOYER
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 1:3301 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3521
Mailing Address - Country:US
Mailing Address - Phone:252-443-7114
Mailing Address - Fax:252-443-7115
Practice Address - Street 1:3301 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3521
Practice Address - Country:US
Practice Address - Phone:252-443-7114
Practice Address - Fax:252-443-7115
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC516213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910038Medicaid