# KENNETH P MOORE, MD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DBA Ruby Valley Urology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588733349
- **Authorized official:** DR. KENNETH PAGE MOORE MD (CEO RUBY VALLEY UROLOGY)
- **Authorized official phone:** (775) 738-2218

## Contact information

- **Practice address:** 1995 ERRECART BLVD, SUITE 207, ELKO, NV 89801-8337
- **Practice address phone:** (775) 738-2218
- **Mailing address:** 1995 ERRECART BLVD, SUITE 207, ELKO, NV 89801-8337
- **Mailing address phone:** (775) 738-2218
- **Mailing address fax:** (775) 738-2219

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/07/2006
- **Last updated:** 06/23/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100506958 | — | NV |