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NPI Code Detail

MEDICARE: DR. JOHN ERIC MOORE D.O.

MEDICARE: DR. JOHN ERIC MOORE D.O.
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
1207Q00000XFamily Medicine Physician01022001116VA

General Provider Information

NPI Number : 1063412070
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN ERIC MOORE D.O.
Provider Business Mailing Address
First Line : 40220 SADDLEBROOK ST
Second Line :
City : MURRIETA
State : CA
Zip : 92563-6100
Country : US
Telephone Number : 951-600-9640
Fax Number :
Provider Business Practice Location Address
First Line : 55 W TIETAN ST
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-4498
Country : US
Telephone Number : 509-525-3720
Fax Number : 509-522-1593
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2005
Last Update Date : 03/25/2020

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Directions to “ DR. JOHN ERIC MOORE D.O.” Practice Location

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