Healthcare Provider Details

I. General information

NPI: 1922077197
Provider Name (Legal Business Name): WILLIAM A MOON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 S PARKER RD #202
DENVER CO
80231-2159
US

IV. Provider business mailing address

1241 S PARKER RD #202
DENVER CO
80231-2159
US

V. Phone/Fax

Practice location:
  • Phone: 303-337-3623
  • Fax: 303-337-3695
Mailing address:
  • Phone: 303-337-3623
  • Fax: 303-337-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number13766
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: