Individual
DR. MICHAEL BENJAMIN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
9040 FITZSIMMONS DR, JOINT BASE LEWIS MCCHORD, WA 98431-3689
(253) 968-1340
Mailing address
9040 FITZSIMMONS DR, JOINT BASE LEWIS MCCHORD, WA 98431-3689
(253) 968-1340
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
OP61069996
WA
207Q00000X
Family Medicine Physician
1198
NE
208D00000X
General Practice Physician
1198
NE
Other
Enumeration date
05/12/2006
Last updated
01/07/2021
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