Individual
MICHAEL DAVID MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5792 WIDEWATERS PKWY STE 101, SYRACUSE, NY 13214-1847
(315) 422-4412
Mailing address
5792 WIDEWATERS PKWY STE 101, SYRACUSE, NY 13214-1847
(315) 422-4412
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
207748
NY
207W00000X
Ophthalmology Physician
G85428
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001620745
PHCS
CA
01
—
00G854280
BLUE SHIELD
CA
05
—
00G854280
—
CA
05
—
01852235
—
NY
01
—
089071
HEALTH NET
CA
01
—
1392936
GREAT WEST
CA
01
—
1767577
UNITED HEALTHCARE
CA
01
—
2258848
FIRST HEALTH
CA
01
—
2700475
CIGNA
CA
01
—
49516
INTERPLAN
CA
01
—
7429234
AETNA
CA
01
—
90121857
PACIFICARE
CA
01
—
937998
FIRST HEALTH
CA
01
—
G85428
BLUE CROSS
CA
01
—
MCMG170200
WESTERN HEALTH ADVANTAGE
CA
Enumeration date
11/04/2006
Last updated
04/27/2019
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