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General NPI Number Information
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NPI Number | 1144673237
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Entity Type | Individual
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Provider Name | TANNER MILES MOORE DPM
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Gender | Male
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 519 ROSE LN
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City | WICKENBURG
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State | AZ
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Zip | 85390-1448
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Country | US
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Telephone | 602-675-0478
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Fax | 602-675-0479
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Provider Business Mailing Address
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Address Line | 523 ROSE LN
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City | WICKENBURG
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State | AZ
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Zip | 85390-1448
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Country | US
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Telephone | 760-613-4402
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Fax |
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD-000936
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License Number State | AZ
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