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General NPI Number Information
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NPI Number | 1255228490
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Entity Type | Organization
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Legal Business Name | SHANE MOORE DPM PC
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Dates
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Enumeration Date | 06/20/2025
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 865 S WATSON RD STE 205
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City | BUCKEYE
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State | AZ
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Zip | 85326-3470
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Country | US
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Telephone | 623-974-0522
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Fax | 623-933-5787
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Provider Business Mailing Address
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Address Line | 13660 N 94TH DR STE D1
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City | PEORIA
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State | AZ
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Zip | 85381-4275
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Country | US
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Telephone | 623-974-0522
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Fax | 623-933-5787
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN SHANE MOORE
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Credential | DPM
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Telephone | 480-241-9848
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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 |
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License Number State |
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