Provider Demographics
NPI:1164584264
Name:G.DOUGLAS MOIR, M.D., INC
Entity Type:Organization
Organization Name:G.DOUGLAS MOIR, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MANORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-741-9318
Mailing Address - Street 1:810 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3402
Mailing Address - Country:US
Mailing Address - Phone:760-741-9318
Mailing Address - Fax:760-741-9484
Practice Address - Street 1:810 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3402
Practice Address - Country:US
Practice Address - Phone:760-741-9318
Practice Address - Fax:760-741-9484
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:G.DOUGLAS MOIR, M.D., INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36411207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20352OtherGROUP ID# (PTAN)
CAA36256Medicare UPIN
CAWC36411AMedicare PIN