# KYLE VON MOORE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1154785616
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 11273463-1204 | UT | Yes |
| 207Q00000X | Family Medicine Physician | 62587 | MN | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | 11273463-1204 | UT | — |

## Other

- **Enumeration date:** 04/11/2016
- **Last updated:** 06/18/2019