Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A149091 | CA |
Y | 111NI0900X | Internist | A149091 | CA |
N | 207R00000X | Internist | PG168290 | OR |
N | 111NI0900X | Internist | PG168290 | OR |
N | 207RH0000X | Hematologist | A149091 | CA |
N | 207RX0202X | Medical Oncology | A149091 | CA |
NPI | 1073925343 |
---|---|
Provider Name | Dr. Justin Moyers |
First Address | Loma Linda, CA 92354 |
Second Address | Loma Linda, CA 92354-2804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2014 |
Last Update Date | 16/06/2018 |