Provider Demographics
NPI:1215919345
Name:MOYE, PHILIP KEVIN (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:KEVIN
Last Name:MOYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 JACOBS CREST CV
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-7830
Mailing Address - Country:US
Mailing Address - Phone:770-778-6230
Mailing Address - Fax:888-675-7353
Practice Address - Street 1:3601 SW 160TH AVE
Practice Address - Street 2:SUITE #250
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6308
Practice Address - Country:US
Practice Address - Phone:305-866-9951
Practice Address - Fax:877-284-8933
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61987207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000025442Medicaid
AL051025442OtherBCBS PROVIDER NUMBER
AL009912168Medicaid
AL051541338OtherBCBS
GA202I082666Medicare PIN
F59517Medicare UPIN
AL000025442Medicaid
051559150Medicare PIN
AL009912168Medicaid
AL051025442Medicare PIN
AL051559150Medicare PIN