# MARY E. MOYER, MD

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

## Provider details

- **NPI number:** 1992817134
- **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:** 08/31/2006
- **Last updated:** 06/21/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 112590 | ACCHS | AZ |
| 01 | — | AZ0325350 | BLUE CROSS BLUE SHIELD | AZ |