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General NPI Number Information
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NPI Number | 1306940739
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Entity Type | Individual
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Provider Name | KEVIN R MOORE MD
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 100 N MEDICAL DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84113-1103
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Country | US
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Telephone | 801-662-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 869 E 4500 S PMB 511
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-3049
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Country | US
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Telephone | 801-487-0451
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Fax | 801-487-2467
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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 | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | 273877-1205
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License Number State | UT
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