Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OI00000417 | WA |
N | 222Z00000X | Podiatrist | OI00000417 | WA |
Y | 224P00000X | Prosthetist | PS00000418 | WA |
NPI | 1033403886 |
---|---|
Provider Name | Christopher Paul Moore |
First Address | Coeur D Alene, ID 83814-2662 |
Second Address | Coeur D Alene, ID 83814-2662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2011 |
Last Update Date | 08/06/2011 |