Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A100506 | CA |
NPI | 1003094749 |
---|---|
Provider Name | Dr. Ryan Timothy Moore |
First Address | Loma Linda, CA 92350-1700 |
Second Address | Loma Linda, CA 92350-1700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2008 |
Last Update Date | 05/02/2008 |