MEDICARE: NICOLA L MOORE M.D.

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	223184	MA
2	207Q00000X	Family Medicine Physician	89646	CA
3	207Q00000X	Family Medicine Physician	37992	IA
4	207Q00000X	Family Medicine Physician	24762	NE
5	207Q00000X	Family Medicine Physician	219226	NY
6	207Q00000X	Family Medicine Physician	01898	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134166184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLA L MOORE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4557
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50305-4557
Country	:	US
Telephone Number	:	866-290-4325
Fax Number	:	515-280-9525

Provider Business Practice Location Address
First Line	:	1000 E ARMY POST RD
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50315-5939
Country	:	US
Telephone Number	:	515-280-7000
Fax Number	:

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	10/27/2009

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Directions to “ NICOLA L MOORE M.D.” Practice Location

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