MEDICARE: DR. MOORE AUDIOLOGY LLC

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	231H00000X	Audiologist

General Provider Information

NPI Number	:	1295435188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MOORE AUDIOLOGY LLC

Provider Business Mailing Address
First Line	:	14633 N DEL WEBB BLVD
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-2144
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14633 N DEL WEBB BLVD
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-2144
Country	:	US
Telephone Number	:	623-250-1500
Fax Number	:

Authorized Official
Title or Position	:	OWNER/AUD
Name	:	GREGORY MOORE
Credential	:
Telephone Number	:	623-250-1500

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	03/08/2023

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