Individual
ANDREW MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1900 N STATE ST STE 105, PROVO, UT 84604-1354
(801) 655-5245
Mailing address
1900 N STATE ST STE 105, PROVO, UT 84604-1354
(801) 655-5245
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
8198024-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000610833
ANTHEM
KY
01
—
000000610836
ANTHEM
KY
01
—
0722557
MEDICARE - FOUNDATION
KY
05
—
200947330
—
IN
01
—
3726871000
PASSPORT ADVANTAGE SPECIALITY
KY
01
—
3726872000
PASSPORT ADVANTAGE PCP
KY
01
—
3726875000
PASSPORT ADVANTAGE
KY
01
—
50024901
PASSPORT SPECIALTY
KY
01
—
50024902
PASSPORT PCP
KY
01
—
50024905
PASSPORT SPECIALITY
KY
05
—
7100074130
—
KY
01
—
9328408
AETNA
KY
Enumeration date
05/03/2007
Last updated
02/23/2022
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