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Individual

KEITH FERTEY MOY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA STUDENT

Contact information

Practice address
530 3RD ST NW, ELK RIVER, MN 55330-1445
(763) 587-4800
(763) 587-4845
Mailing address
8170 33RD AVE S, MS 21110Q, BLOOMINGTON, MN 55425-4516

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13657
MN

Other

Enumeration date
12/16/2019
Last updated
09/09/2021
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