MEDICARE: DR. CAROLYN SHAY 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	207Q00000X	Family Medicine Physician	01069299A	IN
2	207Q00000X	Family Medicine Physician	125056768	IL
3	207Q00000X	Family Medicine Physician	DR.0057420	CO

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	:	1881821296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN SHAY MOORE MD

Provider Business Mailing Address
First Line	:	4380 AUSTIN BLUFFS PKWY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2932
Country	:	US
Telephone Number	:	719-259-6566
Fax Number	:

Provider Business Practice Location Address
First Line	:	4380 AUSTIN BLUFFS PKWY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2932
Country	:	US
Telephone Number	:	719-259-6566
Fax Number	:

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

Provider Enumeration Date	:	06/12/2009
Last Update Date	:	03/21/2025

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