| Doctor Name: | DR. MATTHEW EDWARD MOORE |
| NPI Number: | 1215233440 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 02004259A |
| Business Practice Address: | 4102 Pinion Dr 10 Mdg Usaf Academy, CO - 80840 |
| Business Phone Number: | 7193335183 |
| Business Fax Number: | |
| Mailing Address: | 4102 Pinion Dr, 10 Mdg USAF ACADEMY |
| State: | CO |
| Postal Code: | 80840 |
| Phone Number: | 7193335183 |
| Fax Number: | |
| NPI Enumeration Date: | 02/05/2011 |
| NPI Last Update Date: | 07/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 02004259A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |