MEDICARE: DR. KATHRYN MCCALLUM MOORE

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	174M00000X	Veterinarian	712	AK

General Provider Information

NPI Number	:	1447669072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN MCCALLUM MOORE

Provider Business Mailing Address
First Line	:	3900 LAKE OTIS PKWY
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5210
Country	:	US
Telephone Number	:	907-562-7387
Fax Number	:	907-562-7318

Provider Business Practice Location Address
First Line	:	3900 LAKE OTIS PKWY
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5210
Country	:	US
Telephone Number	:	907-562-7387
Fax Number	:	907-562-7318

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

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	08/07/2014

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