Healthcare Provider Details

I. General information

NPI: 1447697321
Provider Name (Legal Business Name): DREW WESLEY MOORE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 QUIVIRA RD
LENEXA KS
66215-3902
US

IV. Provider business mailing address

982055 NEBRASKA MEDICAL CTR
OMAHA NE
68198-2055
US

V. Phone/Fax

Practice location:
  • Phone: 913-944-4900
  • Fax:
Mailing address:
  • Phone: 402-559-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number05-41563
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6943
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2018030152
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: