MEDICARE: JOHN C MOORE MD PC

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	24909	CO

General Provider Information

NPI Number	:	1760639009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN C MOORE MD PC

Provider Business Mailing Address
First Line	:	88 INVERNESS CIR E
Second Line	:	K102
City	:	ENGLEWOOD
State	:	CO
Zip	:	80112-5304
Country	:	US
Telephone Number	:	702-234-1895
Fax Number	:

Provider Business Practice Location Address
First Line	:	88 INVERNESS CIR E
Second Line	:	K102
City	:	ENGLEWOOD
State	:	CO
Zip	:	80112-5304
Country	:	US
Telephone Number	:	702-234-1895
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RAGGIO COLBY
Credential	:	MD
Telephone Number	:	702-234-1895

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	12/11/2008

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