Active NPI
Victor De Moya, M.D.
- Psychiatry Physician
- Fort Walton Beach, FL
National Provider Identifier
1609988112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 53869
- Practice address
- 403A Hollywood Blvd,, NW
Suite 104
Fort Walton Beach, FL 32548-4531 - Phone
- (850) 244-0101
- Fax
- (850) 243-9795
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 53869 | FL | Primary |
Addresses
Primary practice location
403A Hollywood Blvd,, NW
Suite 104
Fort Walton Beach, FL 32548-4531
Mailing address
403A Hollywood Blvd,, NW
Suite 104
Fort Walton Beach, FL 32548-4531
Phone (850) 244-0101
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09760 | Other | FL | BLUE CROSS/BLUE SHIELD FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2017 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53869 | FL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333584000000",
"number": "1609988112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403A HOLLYWOOD BLVD,, NW",
"address_2": "SUITE 104",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325484531",
"telephone_number": "850-244-0101",
"fax_number": "850-243-9795"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403A HOLLYWOOD BLVD,, NW",
"address_2": "SUITE 104",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325484531",
"telephone_number": "850-244-0101",
"fax_number": "850-243-9795"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE MOYA",
"first_name": "VICTOR",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2012-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "FL",
"license": "53869",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD FL",
"identifier": "09760",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.