Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 238120 | MA |
N | 207XS0117X | Orthopaedic Spine Surgeon | 237490 | NY |
N | 207XS0117X | Orthopaedic Spine Surgeon | 238120 | MA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | A87788 | CA |
NPI | 1134387293 |
---|---|
Provider Name | Derek W Moore |
First Address | Santa Barbara, CA 93105-4330 |
Second Address | Santa Barbara, CA 93105-4330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 15/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2164035 | (05) | MA |