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General NPI Number Information
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NPI Number | 1619356961
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Entity Type | Individual
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Provider Name | SCOTT RICHARD MOORE D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 1775 DEMPSTER ST
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City | PARK RIDGE
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State | IL
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Zip | 60068-1143
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Country | US
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Telephone | 708-283-5500
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Fax | 847-723-0118
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Provider Business Mailing Address
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Address Line | 29373 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1293
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Country | US
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Telephone | 847-390-5900
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | NA
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 5151015314
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 036.171872
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License Number State | IL
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