Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 61987 | GA |
N | 207QA0505X | Family Doctor - Adult Medicine | 61987 | GA |
NPI | 1215919345 |
---|---|
Provider Name | Philip Kevin Moye |
First Address | Grayson, GA 30017-7830 |
Second Address | Miramar, FL 33027-6308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 10/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000025442 | (05) | AL |
009912168 | (05) | AL |
051025442 | BCBS PROVIDER NUMBER (01) | AL |
051541338 | BCBS (01) | AL |
F59517 | (02) | |
F59517 | (02) | AL |