Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 46268 | KY |
Y | 208000000X | Pediatrician | 46268 | KY |
NPI | 1285954461 |
---|---|
Provider Name | James Edward Moyer |
First Address | Chicago, IL 60677-6879 |
Second Address | Louisville, KY 40207-4724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2010 |
Last Update Date | 26/10/2020 |