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General NPI Number Information
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NPI Number | 1821351875
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Entity Type | Individual
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Provider Name | TYLER B MOORE MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 101 THE CITY DR S ORTHOPAEDIC DEPARTMENT
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City | ORANGE
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State | CA
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Zip | 92868-3201
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Country | US
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Telephone | 714-456-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 HARRISON ST, 7TH FL
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City | OAKLAND
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State | CA
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Zip | 94612-3429
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Country | US
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Telephone | 510-625-2856
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Fax | 877-738-4262
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A126302
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 10785573-1205
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License Number State | UT
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