Individual
DR. THEODORE BRUCE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10833 LE CONTE AVE, 12-441 MDCC, LOS ANGELES, CA 90095-3075
(310) 825-6708
(310) 206-8089
Mailing address
10833 LE CONTE AVE, 12-441 MDCC, LOS ANGELES, CA 90095-3075
(310) 825-6708
(310) 206-8089
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
G69308
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G693080
—
CA
05
—
GR0053510
—
CA
Enumeration date
08/17/2006
Last updated
08/27/2012
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