Basic Information
Provider Information
NPI: 1922076306
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOYER
FirstName: GAYLE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 24 FRANK LLOYD WRIGHT DR
Address2: PO BOX 0446 LOBBY J
City: ANN ARBOR
State: MI
PostalCode: 481059484
CountryCode: US
TelephoneNumber: 7347476766
FaxNumber: 7342223100
Practice Location
Address1: 4936 W CLARK RD
Address2: BUILDING D, SUITE 100
City: YPSILANTI
State: MI
PostalCode: 481970861
CountryCode: US
TelephoneNumber: 7344346200
FaxNumber: 7344347373
Other Information
ProviderEnumerationDate: 03/10/2006
LastUpdateDate: 10/12/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X4301055591MIY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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