Provider Demographics
NPI:1104080019
Name:MICHAEL MOYER MD PA
Entity type:Organization
Organization Name:MICHAEL MOYER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-671-7141
Mailing Address - Street 1:PO BOX 721239
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32872-1239
Mailing Address - Country:US
Mailing Address - Phone:407-671-7141
Mailing Address - Fax:407-671-7104
Practice Address - Street 1:3592 ALOMA AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4012
Practice Address - Country:US
Practice Address - Phone:407-671-7141
Practice Address - Fax:407-671-7104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL217Medicare PIN