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General NPI Number Information
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NPI Number | 1760208235
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Entity Type | Individual
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Provider Name | DANIEL CASSADY MOORE PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 11/29/2024
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Last Update Date | 11/29/2024
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Provider Practice Location Address
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Address Line | 10TH MEDICAL GROUP 4102 PINION DRIVE
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City | USAF ACADEMY
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State | CO
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Zip | 80840
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Country | US
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Telephone | 719-333-5245
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Fax |
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Provider Business Mailing Address
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Address Line | 10560 SILVER ORE PT APT 202
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City | COLORADO SPRINGS
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State | CO
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Zip | 80908-5331
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Country | US
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Telephone | 336-465-2114
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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