Provider Demographics
NPI:1538148994
Name:MOYER, WAYNE ALLEN (DPM)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:ALLEN
Last Name:MOYER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13660N 94TH DR A3
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4836
Mailing Address - Country:US
Mailing Address - Phone:623-933-4645
Mailing Address - Fax:623-977-4482
Practice Address - Street 1:13660 N 94TH DR
Practice Address - Street 2:STE A-3
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4836
Practice Address - Country:US
Practice Address - Phone:623-933-4645
Practice Address - Fax:623-977-4482
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0407213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6023360001Medicare NSC
AZZ108166Medicare PIN