Provider Demographics
NPI:1679766133
Name:MOYLES, KYLE JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:JOSEPH
Last Name:MOYLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5300
Mailing Address - Country:US
Mailing Address - Phone:321-500-4263
Mailing Address - Fax:888-782-9622
Practice Address - Street 1:1310 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5300
Practice Address - Country:US
Practice Address - Phone:321-500-4263
Practice Address - Fax:888-782-9622
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113873207X00000X, 207XS0106X
FLTRN11236207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1779268OtherCIGNA
FLLB406OtherFL HFMG MEDICARE
FL3469293OtherUNITED HEALTHCARE
FLLE632OtherFL HFMG
FL14QH3OtherFLORIDA BLUE PROVIDER ID
FL2514077OtherCOVENTRY
FL019539100Medicaid
FL9434935OtherAETNA