Provider Demographics
NPI:1114098316
Name:MOORE, STEVEN VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:VINCENT
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 UPPER RAGSDALE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7881
Mailing Address - Country:US
Mailing Address - Phone:831-655-4263
Mailing Address - Fax:
Practice Address - Street 1:19 UPPER RAGSDALE DR STE 150
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7881
Practice Address - Country:US
Practice Address - Phone:831-655-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG057399174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist