MEDICARE: THOMAS P MOORE MD PHD PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	207X00000X	Orthopaedic Surgery Physician

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	:	1326276783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS P MOORE MD PHD PC

Provider Business Mailing Address
First Line	:	100 ELK RUN DR STE 229
Second Line	:
City	:	BASALT
State	:	CO
Zip	:	81621-9244
Country	:	US
Telephone Number	:	970-927-3714
Fax Number	:	970-927-9555

Provider Business Practice Location Address
First Line	:	32 CRESTED MT. WAY
Second Line	:
City	:	MT. CRESTED BUTTE
State	:	CO
Zip	:	81225
Country	:	US
Telephone Number	:	970-349-2677
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. THOMAS PAUL MOORE
Credential	:	MD PHD PC
Telephone Number	:	970-927-3344

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	02/07/2024

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