Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 006433 | AZ |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 006433 | AZ |
N | 208200000X | Surgeon | 006433 | AZ |
N | 208600000X | Surgeon | 006433 | AZ |
NPI | 1346575081 |
---|---|
Provider Name | Nathan Thomas Moore |
First Address | Phoenix, AZ 85023-1266 |
Second Address | Goodyear, AZ 85338-1226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2009 |
Last Update Date | 29/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
916205 | (05) | AZ |