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Individual

DR. FLETCHER BRADY MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
834 SHERIDAN ST, PORT TOWNSEND, WA 98368-2443
(360) 385-2200
Mailing address
111 OAKWOOD RD, EAST PEORIA, IL 61611-1853
(309) 740-4272

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036-157557
IL
2085R0202X
Diagnostic Radiology Physician
27931
WV
2085R0202X
Diagnostic Radiology Physician
D88788
MD
2085R0202X
Diagnostic Radiology Physician
Primary
MD61681839
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
086220957
DC
05
184182300
MD
05
2334210
WA
Enumeration date
04/30/2015
Last updated
07/11/2025
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