1265590640 NPI number — MS. LYNTON BROOKES MOORE BS

Table of content: MS. LYNTON BROOKES MOORE BS (NPI 1265590640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265590640 NPI number — MS. LYNTON BROOKES MOORE BS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
LYNTON
Provider Middle Name:
BROOKES
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265590640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-252-3200
Provider Business Mailing Address Fax Number:
970-252-3208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 ASPEN ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NORWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-327-4449
Provider Business Practice Location Address Fax Number:
970-327-4676
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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