Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 07342 | MS |
Y | 111NI0900X | Internist | 07342 | MS |
NPI | 1003037854 |
---|---|
Provider Name | Dr. Ruby Moy |
First Address | Canton, MS 39046-4845 |
Second Address | Canton, MS 39046-4845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |