MEDICARE: DR. EDWARD ANTHONY 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	2084P0800X	Psychiatry Physician	A35781	CA
2	2084P0802X	Addiction Psychiatry Physician	A35781	CA

General Provider Information

NPI Number	:	1730269945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD ANTHONY MOORE M.D.

Provider Business Mailing Address
First Line	:	9171 WILSHIRE BLVD
Second Line	:	SUITE 615
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5530
Country	:	US
Telephone Number	:	310-550-5810
Fax Number	:	310-550-5811

Provider Business Practice Location Address
First Line	:	9171 WILSHIRE BLVD
Second Line	:	SUITE 615
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5530
Country	:	US
Telephone Number	:	310-550-5810
Fax Number	:	310-550-5811

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/27/2007

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