Individual
DR. RANDY LEE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2880 NW STEWART PKWY STE 100, ROSEBURG, OR 97471-1201
(541) 673-2267
(541) 672-9483
Mailing address
PO BOX 833, WINCHESTER, OR 97495-0833
(541) 673-2267
(541) 672-9483
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
DO26902
OR
2085R0203X
Therapeutic Radiology Physician
28947
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016146005
BCBS
OR
05
—
026535
—
OR
05
—
16753
—
ND
01
—
P00332817
RAILROAD MEDICARE
OR
Enumeration date
05/30/2006
Last updated
11/29/2021
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