DataLabs

datalabs.health made in the usa

Contact us Sign in | Documentation |

divider

Medicare/Medicaid Verification Programs divider

divider

Medicare Verification Program divider

divider

1558686253

NPI Code Detail

MEDICARE: PAUL ROBERT MOORE RN, CRNA

MEDICARE: PAUL ROBERT MOORE RN, CRNA

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	367500000X	Certified Registered Nurse Anesthetist	CRNA-01077	NM
2	367500000X	Certified Registered Nurse Anesthetist	R1778687	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558686253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ROBERT MOORE RN, CRNA

Provider Business Mailing Address
First Line	:	PO BOX 844088
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4088
Country	:	US
Telephone Number	:	505-609-2258
Fax Number	:	505-609-2259

Provider Business Practice Location Address
First Line	:	801 W MAPLE ST
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5630
Country	:	US
Telephone Number	:	505-609-2000
Fax Number	:	505-609-2259

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

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	06/10/2026

Similar Medicare Providers

1871445304 — EMMA RHIANNON WHITE
Practice Location Address:

801 W MAPLE ST
FARMINGTON, NM
87401-5630

Practice Phone: 505-609-2000
Practice Fax:

1427058510 — SAN JUAN REGIONAL MEDICAL CENTER, INC.
Practice Location Address:

801 W MAPLE ST
FARMINGTON, NM
87401-5630

Practice Phone: 505-325-5011
Practice Fax: 505-609-6249

1841278231 — CHARLES BRAUN MD
Practice Location Address:

801 W MAPLE ST , SAN JUAN REGIONAL MEDICAL CENTER / HOSPITALISTS
FARMINGTON, NM
87401-5630

Practice Phone: 505-609-6463
Practice Fax:

1265405302 — JAN A GOTTA M.D.
Practice Location Address:

801 W MAPLE ST
FARMINGTON, NM
87401-5630

Practice Phone: 505-326-6400
Practice Fax: 505-326-4606

1710950647 — CHARLES E BRUERD D.O.
Practice Location Address:

801 W MAPLE ST
FARMINGTON, NM
87401-5630

Practice Phone: 505-326-6400
Practice Fax: 505-326-4606

1487627311 — MR. DENNIS J WOODS CRNA
Practice Location Address:

801 W MAPLE ST
FARMINGTON, NM
87401-5630

Practice Phone: 505-609-6161
Practice Fax: 505-330-3865

Directions to “ PAUL ROBERT MOORE RN, CRNA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.