Basic Information
| Provider Information | |||||||||
| NPI: | 1386639789 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOINESTER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 995 S YATES RD | ||||||||
| Address2: | 2 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381190882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017630461 | ||||||||
| FaxNumber: | 9016819820 | ||||||||
| Practice Location | |||||||||
| Address1: | 6575 STAGE RD | ||||||||
| Address2: | |||||||||
| City: | BARTLETT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381343809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013820393 | ||||||||
| FaxNumber: | 9017634326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 07/21/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | DPM 194 | TN | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3351646 | 05 | TN | MEDICAID |