Individual
BRIAN S MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5555 GROSSMONT CENTER DR, LA MESA, CA 91942-3019
(619) 740-4000
(619) 740-4207
Mailing address
7777 ALVARADO RD, #108, LA MESA, CA 91942
(619) 460-2770
(619) 460-2774
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
G68336
CA
2085R0202X
Diagnostic Radiology Physician
G683360
CA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
G68336
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G683360
BLUE SHIELD PIN
CA
05
—
00G683360
—
CA
01
—
10963841
CAQH
—
Enumeration date
05/24/2006
Last updated
03/19/2019
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