Individual
GLEN O MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8383 W ALAMEDA AVE, LAKEWOOD, CO 80226-3007
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA0004150
CO
Other
Enumeration date
11/07/2014
Last updated
11/02/2022
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