MEDICARE: DR. WILLIAM A MOON M.D.

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	173000000X	Legal Medicine	13766	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	:	1922077197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM A MOON M.D.

Provider Business Mailing Address
First Line	:	1241 S PARKER RD
Second Line	:	#202
City	:	DENVER
State	:	CO
Zip	:	80231-2159
Country	:	US
Telephone Number	:	303-337-3623
Fax Number	:	303-337-3695

Provider Business Practice Location Address
First Line	:	1241 S PARKER RD
Second Line	:	#202
City	:	DENVER
State	:	CO
Zip	:	80231-2159
Country	:	US
Telephone Number	:	303-337-3623
Fax Number	:	303-337-3695

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/08/2007

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