Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 128607 | NC |
N | 208600000X | Surgeon | 128607 | NC |
N | 208200000X | Surgeon | 0101-253023 | VA |
N | 208600000X | Surgeon | 0101-253023 | VA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 0101-253023 | VA |
NPI | 1174780811 |
---|---|
Provider Name | Kurtis Eugene Moyer |
First Address | Roanoke, VA 24016-4955 |
Second Address | Roanoke, VA 24016-4955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2008 |
Last Update Date | 10/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VV8610A | MEDICARE PTAN (01) | VA |