Individual
KENNETH STEVEN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
10401 WEST THUNDERBIRD BOULEVARD, SUN CITY, AZ 85351
(623) 977-7211
Mailing address
2100 POWELL STREET STE 920, EMERYVILLE, CA 94608-1803
(510) 350-2777
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2015039936
MO
207P00000X
Emergency Medicine Physician
Primary
35466
AZ
207P00000X
Emergency Medicine Physician
G36840
CA
207P00000X
Emergency Medicine Physician
MD4625
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114536
—
AZ
Enumeration date
05/10/2006
Last updated
10/25/2018
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