Basic Information
| Provider Information | |||||||||
| NPI: | 1902994056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOYER | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | ADDISON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2817 REILLY ROAD MCXC-COD CREDENTIALS | ||||||||
| Address2: | WOMACK ARMY MEDICAL CENTER | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109078922 | ||||||||
| FaxNumber: | 9109076069 | ||||||||
| Practice Location | |||||||||
| Address1: | D-2004 MARION ST | ||||||||
| Address2: | PSYCHOLOGICAL APPLICATIONS DIRECTORATE | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104326833 | ||||||||
| FaxNumber: | 9104329197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 1620 | NC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.