MEDICARE: DR. DAVID W 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	174400000X	Specialist	MD00020153	WA

General Provider Information

NPI Number	:	1295812584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID W MOORE M.D

Provider Business Mailing Address
First Line	:	1221 MADISON ST
Second Line	:	SUITE#1523
City	:	SEATTLE
State	:	WA
Zip	:	98104-3588
Country	:	US
Telephone Number	:	206-292-6464
Fax Number	:	206-292-6498

Provider Business Practice Location Address
First Line	:	1221 MADISON ST
Second Line	:	SUITE#1523
City	:	SEATTLE
State	:	WA
Zip	:	98104-3588
Country	:	US
Telephone Number	:	206-292-6464
Fax Number	:	206-292-6498

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/25/2021

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