Provider Demographics
NPI:1154366904
Name:MOYER, GAROLD L (MD)
Entity type:Individual
Prefix:DR
First Name:GAROLD
Middle Name:L
Last Name:MOYER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2101 KIMBALL AVE
Mailing Address - Street 2:LL14
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5063
Mailing Address - Country:US
Mailing Address - Phone:319-272-1590
Mailing Address - Fax:319-272-1535
Practice Address - Street 1:2710 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 111
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5619
Practice Address - Country:US
Practice Address - Phone:319-272-7425
Practice Address - Fax:319-272-8059
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2007-07-19
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Provider Licenses
StateLicense IDTaxonomies
IA21572207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1183806Medicaid
IA1183806Medicaid
IAA02129Medicare UPIN