Individual
NICHOLAS J.E. MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1390 KELLY JOHNSON BLVD, COLORADO SPRINGS, CO 80920-3908
(719) 593-1799
Mailing address
1390 KELLY JOHNSON BLVD, COLORADO SPRINGS, CO 80920-3908
(719) 593-1799
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
48664
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88639266
MEDICAID
CO
Enumeration date
05/05/2006
Last updated
03/07/2023
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