Individual
TIM J MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1329 GUSDORF RD, TAOS, NM 87571
(575) 758-5001
(575) 737-5046
Mailing address
1329 GUSDORF RD, TAOS, NM 87571
(575) 758-5001
(575) 737-5046
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD2008-0111
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3125165
—
MA
05
—
60122838
—
NM
Enumeration date
05/03/2006
Last updated
02/03/2012
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