Individual
DR. MILAN SHANNON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3901 CAPITAL MALL DR SW STE A, OLYMPIA, WA 98502-8654
(360) 786-8990
(360) 786-9010
Mailing address
PO BOX 368, OLYMPIA, WA 98507-0368
(360) 491-8439
(360) 491-6328
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD00039784
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1001556
—
WA
01
—
148355
LABOR & INDUSTRIES
WA
01
—
5918MO
REGENCE
WA
01
—
8275349
DSHS
WA
01
—
GAB21356
MEDICARE LEGACY
WA
Enumeration date
01/06/2006
Last updated
01/20/2024
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