Healthcare Provider Details

I. General information

NPI: 1275570301
Provider Name (Legal Business Name): NATHANIEL J MOORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 S LOGAN ST
DENVER CO
80209
US

IV. Provider business mailing address

15101 E ILIFF AVE STE 140
AURORA CO
80014-4548
US

V. Phone/Fax

Practice location:
  • Phone: 303-733-3764
  • Fax: 303-733-0868
Mailing address:
  • Phone: 720-878-7055
  • Fax: 720-390-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35543
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35543
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: