MEDICARE: MICHAEL R MOORE MD

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	208600000X	Surgery Physician	MD00027465	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01321265	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0305792	OTHER	WA	LABOR & INDUSTRIES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407828551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL R MOORE MD

Provider Business Mailing Address
First Line	:	PO BOX 421
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-0421
Country	:	US
Telephone Number	:	866-747-2455
Fax Number	:	509-227-7070

Provider Business Practice Location Address
First Line	:	217 W CATALDO AVE FL 3
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-2217
Country	:	US
Telephone Number	:	509-747-6194
Fax Number	:	509-838-0824

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	11/29/2022

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Directions to “ MICHAEL R MOORE MD” Practice Location

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