Dr. Douglas R Moore
Internist - Cardiovascular Disease Clinical Cardiac Electrophysiologist
25195 Kelly Rd Ste A
Roseville
, Michigan 48066-4909
Dr. Douglas R Moore
Internist - Cardiovascular Disease Clinical Cardiac Electrophysiologist
25195 Kelly Rd Ste A
Roseville
, Michigan 48066-4909
(586) 775-4506
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About
Features
Specialties
- Internist - Cardiovascular Disease
- Clinical Cardiac Electrophysiologist
Languages spoken
- English
Location
First Address
- Dr. Douglas R Moore
- 25195 Kelly Rd Ste A
- Roseville, MI
- Zip : 48066-4909
- Fax : (586) 775-4506
- Phone : (586) 775-4594
Second Address
- Dr. Douglas R Moore
- 25195 Kelly Rd Ste A
- Roseville, MI
- Zip : 48066-4909
- Fax : (586) 775-4506
- Phone : (586) 775-4594
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207RC0000X | Internist - Cardiovascular Disease | 0102202087 | VA |
| Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 0102202087 | VA |
| N | 207RC0001X | Clinical Cardiac Electrophysiologist | 5101013212 | MI |
National Provider Identifier
| NPI | 1194729053 |
|---|---|
| Provider Name | Dr. Douglas R Moore |
| First Address | Roseville, MI 48066-4909 |
| Second Address | Roseville, MI 48066-4909 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 09/06/2005 |
| Last Update Date | 10/02/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| I13810 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.