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General NPI Number Information
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NPI Number | 1760639009
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Entity Type | Organization
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Legal Business Name | JOHN C MOORE MD PC
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 88 INVERNESS CIR E K102
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City | ENGLEWOOD
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State | CO
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Zip | 80112-5304
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Country | US
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Telephone | 702-234-1895
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Fax |
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Provider Business Mailing Address
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Address Line | 88 INVERNESS CIR E K102
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City | ENGLEWOOD
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State | CO
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Zip | 80112-5304
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Country | US
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Telephone | 702-234-1895
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RAGGIO COLBY
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Credential | MD
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Telephone | 702-234-1895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 24909
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License Number State | CO
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