Individual
CHARLES D. MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6296 CANARY LN, EL DORADO, CA 95623-4968
(916) 296-3529
Mailing address
6296 CANARY LN, EL DORADO, CA 95623-4968
(916) 296-3529
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A42921
CA
2084P0802X
Addiction Psychiatry Physician
A42921
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A429210
—
CA
Enumeration date
11/01/2006
Last updated
09/22/2024
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