MEDICARE: DR. DEAN L MOORE DPM

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	213E00000X	Podiatrist	1700	TX

General Provider Information

NPI Number	:	1790812816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN L MOORE DPM

Provider Business Mailing Address
First Line	:	1021 COSTA PACIFICA WAY
Second Line	:	UNIT 2213
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-2195
Country	:	US
Telephone Number	:	619-633-8584
Fax Number	:	760-231-9135

Provider Business Practice Location Address
First Line	:	16633 DALLAS PKWY
Second Line	:	SUITE 600
City	:	ADDISON
State	:	TX
Zip	:	75001-6816
Country	:	US
Telephone Number	:	619-633-8584
Fax Number	:	760-231-9135

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	11/10/2015

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Directions to “ DR. DEAN L MOORE DPM” Practice Location

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