Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OI00000461 | WA |
N | 222Z00000X | Podiatrist | OI00000461 | WA |
Y | 224P00000X | Prosthetist | PS00000467 | WA |
NPI | 1396871174 |
---|---|
Provider Name | Mr. Michael G Moor |
First Address | Loma Linda, CA 92354-0036 |
Second Address | Loma Linda, CA 92354-5601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 29/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027853 | (05) | OR |
387074301 | PC65, FC65, PPO (01) | OR |
874024000 | BCBS PAR, PPP, PC (01) | OR |