MEDICARE: DR. BRYAN J 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	2084N0400X	Neurology Physician	27287	MS
2	2084A2900X	Neurocritical Care Physician	61473	MN
3	2084N0400X	Neurology Physician	67009-20	WI
4	2084N0400X	Neurology Physician	MD452380	PA
5	2084N0400X	Neurology Physician	60060	TN
6	2084N0400X	Neurology Physician	4301500317	MI
7	2084N0400X	Neurology Physician	01086940A	IN
8	2084N0400X	Neurology Physician	E-12644	AR
9	2084N0400X	Neurology Physician	25MA10040800	NJ

General Provider Information

NPI Number	:	1104141662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN J MOORE M.D.

Provider Business Mailing Address
First Line	:	525 N ST ANDREWS PL APT 1/2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-2511
Country	:	US
Telephone Number	:	540-998-3646
Fax Number	:

Provider Business Practice Location Address
First Line	:	INTOUCH HEALTH / C3O TELEMEDICINE
Second Line	:	7402 HOLLISTER AVENUE
City	:	SANTA BARBARA
State	:	CA
Zip	:	93117
Country	:	US
Telephone Number	:	805-562-8686
Fax Number	:	805-456-1796

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

Provider Enumeration Date	:	03/28/2010
Last Update Date	:	03/09/2026

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