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General NPI Number Information
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NPI Number | 1164647723
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Entity Type | Organization
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Legal Business Name | MOORE CLINIC INC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 209 MOLLER DRIVE
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City | SITKA
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State | AK
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Zip | 99835
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Country | US
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Telephone | 907-747-2616
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 279
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City | SITKA
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State | AK
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Zip | 99835-0279
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Country | US
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Telephone | 907-747-2616
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN WILSON TOTTEN
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Credential | MD FRCS
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Telephone | 907-747-3446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 227080
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 227080
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 227080
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License Number State | AK
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 227080
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License Number State | AK
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