Individual
BLAKE WALTER MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0101256077
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992903769
HEALTH NET FEDERAL SERVICES
VA
05
—
1992903769
—
VA
01
—
5604405
CIGNA
VA
01
—
7505953
AETNA
VA
Enumeration date
07/03/2007
Last updated
10/28/2020
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