Provider Demographics
NPI:1730531096
Name:MOYER, WILLIE JUNIOR III
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:JUNIOR
Last Name:MOYER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 E ESCOBA DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-5522
Mailing Address - Country:US
Mailing Address - Phone:336-423-2576
Mailing Address - Fax:
Practice Address - Street 1:3055 E ESCOBA DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-5522
Practice Address - Country:US
Practice Address - Phone:336-423-2576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility