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Individual
BRIAN S MOORE
Active
Individual
BRIAN S MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
G68336
CA
2085R0202X
Diagnostic Radiology Physician
G683360
CA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
G68336
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G683360
BLUE SHIELD PIN
CA
05
—
00G683360
—
CA
01
—
10963841
CAQH
—
Enumeration date
05/24/2006
Last updated
03/19/2019
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