Healthcare Provider Details

I. General information

NPI: 1326276783
Provider Name (Legal Business Name): THOMAS P MOORE MD PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 CRESTED MT. WAY
MT. CRESTED BUTTE CO
81225
US

IV. Provider business mailing address

100 ELK RUN DR STE 229
BASALT CO
81621-9244
US

V. Phone/Fax

Practice location:
  • Phone: 970-349-2677
  • Fax:
Mailing address:
  • Phone: 970-927-3714
  • Fax: 970-927-9555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS PAUL MOORE
Title or Position: PHYSICIAN
Credential: MD PHD PC
Phone: 970-927-3344