# DOUGLAS BERNARD MOORE

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

## Provider details

- **NPI number:** 1790853422
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA10005095 | WA | Yes |
| 363AM0700X | Medical Physician Assistant | PA10005095 | WA | — |

## Other

- **Enumeration date:** 12/01/2006
- **Last updated:** 01/31/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0215666 | LABOR AND INDUSTRIES-TRA | WA |
| 01 | — | 0249530 | LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST | WA |
| 01 | — | 8862652 | MEDICARE PIN-TRA PIERCE | WA |
| 01 | — | 8862653 | MEDICARE PIN-TRA KING | WA |
| 01 | — | 8862654 | MEDICARE PIN-UNION AVENUE OPEN MRI | WA |
| 01 | — | 8943157 | LABOR AND INDUSTRIES CRIME VICTIMS-TRA | WA |
| 01 | — | 8951854 | LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST | WA |
| 01 | — | P00428602 | RR MEDICARE-TRA | WA |