MEDICARE: MICHAEL C MOORE M.D. P. C.

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	174400000X	Specialist	21782	CO

General Provider Information

NPI Number	:	1699924290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL C MOORE M.D. P. C.

Provider Business Mailing Address
First Line	:	7055 JUNIPER DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-4013
Country	:	US
Telephone Number	:	719-495-2175
Fax Number	:

Provider Business Practice Location Address
First Line	:	7055 JUNIPER DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-4013
Country	:	US
Telephone Number	:	719-495-2175
Fax Number	:

Authorized Official
Title or Position	:	PRES
Name	:	DR. MICHAEL C MOORE
Credential	:	MD
Telephone Number	:	719-495-2175

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	09/18/2008

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