Individual
BRET A MOORE
Active
Individual
BRET A MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
087087
IA
363A00000X
Physician Assistant
1436
NE
363A00000X
Physician Assistant
PA10004070
WA
363A00000X
Physician Assistant
PA162693
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0219804
L&I
WA
01
—
087087
IOWA LICENSE
IA
01
—
560910078
MEDICARE PTAN
IA
05
—
8354698
—
WA
Enumeration date
06/30/2006
Last updated
07/21/2022
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