Provider Demographics
NPI:1194764613
Name:MOY, M. LOUIS (MD)
Entity type:Individual
Prefix:
First Name:M.
Middle Name:LOUIS
Last Name:MOY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:LOUIS
Other - Last Name:MOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-273-6815
Mailing Address - Fax:352-392-8846
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1197
Practice Address - Country:US
Practice Address - Phone:352-548-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068676L208800000X
FLME105105208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010374830001Medicaid
FL001315300Medicaid
PA1010374830001Medicaid
FLCI025ZMedicare PIN
PA085450Medicare ID - Type Unspecified