MEDICARE: DR. JULIE A 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	04-23163	KS

General Provider Information

NPI Number	:	1790759538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE A MOORE MD

Provider Business Mailing Address
First Line	:	PO BOX 2027
Second Line	:	338 N FRONT ST WPM PATHOLOGY LABORATORY CHARTERED
City	:	SALINA
State	:	KS
Zip	:	67402-2027
Country	:	US
Telephone Number	:	785-823-7201
Fax Number	:	785-823-7185

Provider Business Practice Location Address
First Line	:	338 N FRONT ST
Second Line	:	WPM PATHOLOGY LABORATORY CHARTERED
City	:	SALINA
State	:	KS
Zip	:	67401
Country	:	US
Telephone Number	:	785-823-7201
Fax Number	:	785-823-7185

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	07/08/2007

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