Individual
DR. MATTHEW RYAN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6500 E 2ND ST, SUITE 200, CASPER, WY 82609-4338
(307) 577-5100
Mailing address
416 S LINCOLN ST, CASPER, WY 82601-3236
(512) 321-8664
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8369A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780912246
BC/BS
—
Enumeration date
11/20/2009
Last updated
09/27/2010
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