Healthcare Provider Details

I. General information

NPI: 1669524815
Provider Name (Legal Business Name): WILLIAM DOWNS MOORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 S COMMERCIAL ST
NEENAH WI
54956-4801
US

IV. Provider business mailing address

9 RUSTIC CT
APPLETON WI
54911-8545
US

V. Phone/Fax

Practice location:
  • Phone: 920-720-0660
  • Fax:
Mailing address:
  • Phone: 920-734-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number24220020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: