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Individual

KYLE VON MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
501 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1222
(801) 581-7951
Mailing address
501 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1222
(801) 581-7951

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11273463-1204
UT
207Q00000X
Family Medicine Physician
62587
MN
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
11273463-1204
UT

Other

Enumeration date
04/11/2016
Last updated
06/18/2019
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