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General NPI Number Information
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NPI Number | 1740389592
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Entity Type | Individual
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Provider Name | STEPHEN MOE MD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2501 WALNUT ST STE 207
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City | BOULDER
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State | CO
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Zip | 80302-5753
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Country | US
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Telephone | 720-339-7920
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Fax | 303-442-1125
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Provider Business Mailing Address
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Address Line | 2501 WALNUT ST STE 207
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City | BOULDER
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State | CO
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Zip | 80302-5753
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Country | US
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Telephone | 720-339-7920
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Fax | 303-442-1125
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 32633
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License Number State | CO
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