Provider Demographics
NPI:1114035466
Name:MOYSE, JOSEPH G
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:MOYSE
Suffix:
Gender:
Credentials:
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:G
Other - Last Name:MOYSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3155 LAKE WORTH RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6917
Mailing Address - Country:US
Mailing Address - Phone:561-858-8817
Mailing Address - Fax:561-878-8277
Practice Address - Street 1:1502 LAKE TRAFFORD RD
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-2618
Practice Address - Country:US
Practice Address - Phone:239-900-9170
Practice Address - Fax:561-878-8277
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM15224174400000X
FLACN252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist