MEDICARE: MR. JOEL AUGUST MOORE MD

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	207X00000X	Orthopaedic Surgery Physician	MD25714	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0199471	OTHER	WA	L&I

General Provider Information

NPI Number	:	1740272046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL AUGUST MOORE MD

Provider Business Mailing Address
First Line	:	2200 NE NEFF RD
Second Line	:	STE 200
City	:	BEND
State	:	OR
Zip	:	97701-4283
Country	:	US
Telephone Number	:	541-382-3344
Fax Number	:	541-382-1681

Provider Business Practice Location Address
First Line	:	271 N EGAN AVE
Second Line	:
City	:	BURNS
State	:	OR
Zip	:	97720-1733
Country	:	US
Telephone Number	:	541-573-4099
Fax Number	:	541-573-8627

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	09/19/2023

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