Doctor Name: | MICHAEL JEFFREY MOORE |
NPI Number: | 1699919639 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | |
Business Practice Address: | 400 Ne Mother Joseph Pl Vancouver, WA - 986643200 |
Business Phone Number: | 3608285396 |
Business Fax Number: | 3608285455 |
Mailing Address: | 505 Ne 87th Ave, Suite 46.5 VANCOUVER |
State: | WA |
Postal Code: | 986641989 |
Phone Number: | 3608285396 |
Fax Number: | 3690828545 |
NPI Enumeration Date: | 04/21/2009 |
NPI Last Update Date: | 07/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OR |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |