Provider Demographics
NPI:1306810254
Name:MOYER, MICHAEL R (PA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:MOYER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26500 AMHEARST CIR
Mailing Address - Street 2:APT. 304
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-8502
Mailing Address - Country:US
Mailing Address - Phone:440-488-6440
Mailing Address - Fax:440-951-3531
Practice Address - Street 1:26500 AMHEARST CIR
Practice Address - Street 2:APT. 304
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-8502
Practice Address - Country:US
Practice Address - Phone:440-488-6440
Practice Address - Fax:440-951-3531
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50000722363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S52952Medicare UPIN
OHPA10157Medicare PIN
OHMOPA10153Medicare ID - Type Unspecified