Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | POD.0000812 | CO |
NPI | 1336550565 |
---|---|
Provider Name | Dr. Garrett D Moore |
First Address | Aurora, CO 80042-0429 |
Second Address | Denver, CO 80238-3324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2014 |
Last Update Date | 17/03/2018 |