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General NPI Number Information
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NPI Number | 1053452250
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Entity Type | Individual
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Provider Name | DENNIS MOORE M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 1003 WALLACE WAY
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City | GRANDVIEW
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State | WA
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Zip | 98930-8805
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Country | US
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Telephone | 509-203-1080
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Fax | 509-203-1077
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Provider Business Mailing Address
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Address Line | 1003 WALLACE WAY
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City | GRANDVIEW
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State | WA
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Zip | 98930-8805
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Country | US
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Telephone | 509-203-1080
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Fax | 509-203-1077
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 9907
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | NV 9907
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD61499857
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License Number State | WA
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