MEDICARE: DR. RYAN TIMOTHY MOORE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	A100506	CA
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	136059	AK

General Provider Information

NPI Number	:	1003094749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN TIMOTHY MOORE M.D.

Provider Business Mailing Address
First Line	:	4739 EGRET ROCK CIR RM 21005
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-4390
Country	:	US
Telephone Number	:	831-917-8761
Fax Number	:

Provider Business Practice Location Address
First Line	:	4739 EGRET ROCK CIR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-4390
Country	:	US
Telephone Number	:	831-917-8761
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	10/09/2024

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