Individual
DR. BLAKE E MOORE
Active
Individual
DR. BLAKE E MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101255929
VA
207X00000X
Orthopaedic Surgery Physician
UID441344
PA
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
0101255929
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C05501
MEDICARE GROUP
VA
Enumeration date
05/15/2008
Last updated
11/07/2023
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