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General NPI Number Information
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NPI Number | 1235132978
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Entity Type | Individual
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Provider Name | MICHAEL ROY MOORE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2005
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 301 W POPLAR ST STE 210
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City | WALLA WALLA
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State | WA
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Zip | 99362-2800
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Country | US
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Telephone | 509-897-5788
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Fax |
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Provider Business Mailing Address
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Address Line | 301 W POPLAR ST
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City | WALLA WALLA
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State | WA
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Zip | 99362-2858
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Country | US
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Telephone | 95-897-8959
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Fax | 95-897-5788
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 33095
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | MD61324152
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | G85748
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD61324152
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License Number State | WA
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