MEDICARE: DR. NEAL O MOORE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	108896	MO

General Provider Information

NPI Number	:	1134129489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEAL O MOORE D.O.

Provider Business Mailing Address
First Line	:	2700 CLAY EDWARDS DR
Second Line	:	SUITE 240
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3251
Country	:	US
Telephone Number	:	816-691-5289
Fax Number	:	816-346-7690

Provider Business Practice Location Address
First Line	:	8800 NW 112TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-1104
Country	:	US
Telephone Number	:	816-464-2333
Fax Number	:	816-464-5272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	10/22/2015

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