Individual
DERRICK ALLEN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1155 MILL ST MS W14, RENO, NV 89502-1576
(775) 982-7878
(775) 982-4196
Mailing address
1155 MILL ST MS M14, RENO, NV 89502-1576
(775) 982-5262
(775) 982-4196
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
10291
NV
208M00000X
Hospitalist Physician
Primary
10291
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110242647
RAILROAD MEDICARE
NV
01
—
11041252
CAQH
—
05
—
1598738098
—
NV
Enumeration date
02/07/2006
Last updated
06/17/2021
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