MEDICARE: RANDALL MOORE

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	207Q00000X	Family Medicine Physician	MD00030411	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841351285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL MOORE

Provider Business Mailing Address
First Line	:	23520 109TH AVENUE
Second Line	:
City	:	MAPLE RIDGE
State	:	BRITISH COLUMBIA
Zip	:	V21 1A8
Country	:	CA
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6760 MISSION RD
Second Line	:
City	:	EVERSON
State	:	WA
Zip	:	98247-9749
Country	:	US
Telephone Number	:	360-966-2106
Fax Number	:

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

Similar Medicare Providers

1366433864 — MS. KATHLEEN ANNETTE PUDERBAUGH ARNP
Practice Location Address:

6760 MISSION RD
EVERSON, WA
98247-9749

Practice Phone: 360-966-2106
Practice Fax: 360-966-2304

1790882819 — DR. BURKE PAK-KING CHEUNG DDS
Practice Location Address:

2510 SULWHANON DRIVE
EVERSON, WA
98247-9749

Practice Phone: 360-306-5151
Practice Fax: 360-306-5191

1568528842 — NOOKSACK CENTRAL MANAGEMENT SYSTEM
Practice Location Address:

6760 MISSION RD
EVERSON, WA
98247-9749

Practice Phone: 360-966-2106
Practice Fax: 360-966-7227

1891843769 — NOOKSACK DENTAL CLINIC
Practice Location Address:

6760 MISSION RD
EVERSON, WA
98247-9749

Practice Phone: 360-306-5151
Practice Fax: 360-306-5191

1932257144 — MARY ELLEN SHIELDS M.D.
Practice Location Address:

6760 MISSION RD
EVERSON, WA
98247-9749

Practice Phone: 360-966-2106
Practice Fax: 360-966-2304

1669521704 — DR. DIANE R STAVES M.D.
Practice Location Address:

2510 SULWHANON DR
EVERSON, WA
98247-9749

Practice Phone: 360-966-2106
Practice Fax: 360-966-2304

Directions to “ RANDALL MOORE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.