Individual
DOMINIC MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-3645
Mailing address
100 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-3645
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
8598327-1205
UT
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
Primary
8598327-1205
UT
Other
Enumeration date
09/28/2009
Last updated
11/30/2021
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