Provider Demographics
NPI:1114152709
Name:MOORE, DAVID R (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 PACIFIC AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4600
Mailing Address - Country:US
Mailing Address - Phone:253-334-4673
Mailing Address - Fax:
Practice Address - Street 1:621 PACIFIC AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4600
Practice Address - Country:US
Practice Address - Phone:253-334-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003591103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical