Individual
CALVIN MOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1506 W REYNOLDS ST, PONTIAC, IL 61764-9674
(815) 844-6123
(815) 884-7851
Mailing address
1506 W REYNOLDS ST, PONTIAC, IL 61764-9674
(815) 844-6123
(815) 884-7851
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-128985
IL
390200000X
Student in an Organized Health Care Education/Training Program
125057045
IL
Other
Enumeration date
06/22/2009
Last updated
11/07/2012
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