1659401073 NPI number — MR. T.F. E. MOORE M.A.

Table of content: MR. T.F. E. MOORE M.A. (NPI 1659401073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659401073 NPI number — MR. T.F. E. MOORE M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
T.F.
Provider Middle Name:
E.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOORE
Provider Other First Name:
TIMOTHY-FRANCIS
Provider Other Middle Name:
E.,
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1659401073
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:
2442 GRAVELLY BEACH LOOP, N.W. # 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98502-8821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-867-1375
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 WEST MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEHALIS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98532-4817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-748-6696
Provider Business Practice Location Address Fax Number:
360-748-0627
Provider Enumeration Date:
03/06/2007

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: 101YM0800X , with the licence number:  RC00033328 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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