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Organization
BRIANT G. MOYLES D.P.M., P.A.
Active
Organization
BRIANT G. MOYLES D.P.M., P.A.
Active
Other names
Melbourne Podiatry Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD C WILSON D.P.M., P.A. (PRESIDENT)
(321) 255-3338
Entity
Organization
Contact information
Practice address
1310 W EAU GALLIE BLVD, SUITE E, MELBOURNE, FL 32935-5300
(321) 255-3338
(321) 253-9643
Mailing address
1515 DR MARTIN LUTHER KING JR BLVD, MELBOURNE, FL 32901-2946
(321) 723-3500
(321) 723-1945
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041009800
—
FL
01
—
72224
BCBS
FL
Enumeration date
04/09/2008
Last updated
02/23/2023
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