Individual
TANNER MILES MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
519 ROSE LN, WICKENBURG, AZ 85390-1448
(602) 675-0478
(602) 675-0479
Mailing address
523 ROSE LN, WICKENBURG, AZ 85390-1448
(760) 613-4402
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD-000936
AZ
Other
Enumeration date
07/13/2016
Last updated
07/08/2021
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