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NPI Code Detail

MEDICARE: JULIA F MOORE M.D.

MEDICARE: JULIA F 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
12084P0800XPsychiatry Physician17254-020WI
22084P0804XChild & Adolescent Psychiatry Physician17254-020WI
32084P0804XChild & Adolescent Psychiatry PhysicianMD00015945WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2A05208OTHERCIGNA
342572OTHERNETWORK HEALTH PLAN

General Provider Information

NPI Number : 1578584298
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIA F MOORE M.D.
Provider Business Mailing Address
First Line : PO BOX 565
Second Line :
City : PORT TOWNSEND
State : WA
Zip : 98368-0565
Country : US
Telephone Number : 360-385-0321
Fax Number : 360-379-5534
Provider Business Practice Location Address
First Line : 884 W PARK AVE
Second Line :
City : PORT TOWNSEND
State : WA
Zip : 98368-2273
Country : US
Telephone Number : 360-385-0321
Fax Number : 360-379-5534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 02/28/2013

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