MEDICARE: MARCIA MONROE 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	28726	OK
2	208600000X	Surgery Physician	2003031471	MO
3	208600000X	Surgery Physician	DR.0067559	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00390780	OTHER	MO	RAILROAD MEDICARE

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	:	1760554521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA MONROE MOORE MD

Provider Business Mailing Address
First Line	:	1 MERCADO ST STE 220
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-7310
Country	:	US
Telephone Number	:	970-764-3450
Fax Number	:	970-382-6607

Provider Business Practice Location Address
First Line	:	4140 W MEMORIAL RD
Second Line	:	STE 408
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8300
Country	:	US
Telephone Number	:	580-436-3980
Fax Number	:	580-421-6205

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	10/22/2021

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Directions to “ MARCIA MONROE MOORE MD” Practice Location

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