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General NPI Number Information
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NPI Number | 1366861767
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Entity Type | Individual
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Provider Name | ANDREW CHRISTOPHER MOORE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2014
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | NBHC NAVAL BASE CORONADO BLDG. 601
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City | SAN DIEGO
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State | CA
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Zip | 92135-7046
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Country | US
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Telephone | 619-545-4359
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Fax | 619-545-0452
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Provider Business Mailing Address
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Address Line | 4136 OREGON ST
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City | SAN DIEGO
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State | CA
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Zip | 92104-1726
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Country | US
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Telephone | 301-767-6247
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 0101258752
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101258752
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License Number State | VA
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