# MARY E. MOYER MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245324003
- **Authorized official:** MR. JOHN C MOYER (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (928) 778-1251

## Contact information

- **Practice address:** 3251 N WINDSONG DR, PRESCOTT VALLEY, AZ 86314-1222
- **Practice address phone:** (928) 772-2582
- **Practice address fax:** (928) 772-2383
- **Mailing address:** 47 N FRENCH DR, PRESCOTT, AZ 86303-6247
- **Mailing address phone:** (928) 778-1251
- **Mailing address fax:** (928) 778-7834

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 19675 | AZ | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | AZ0325351 | NEW BCBS | AZ |