Individual
SHANE EDWARD MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
7700 E FLORENTINE RD STE 203, PRESCOTT VALLEY, AZ 86314-2245
(928) 708-4310
(928) 548-2164
Mailing address
PO BOX 10880, PRESCOTT, AZ 86304-0880
(602) 406-4786
(916) 636-4358
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
011620
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2020
Last updated
06/03/2025
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