Provider Demographics
NPI:1174511935
Name:MOORE, STEVEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-384-9084
Mailing Address - Fax:319-384-8053
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-384-9084
Practice Address - Fax:319-384-8053
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23889207ZN0500X, 207ZP0007X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA33946OtherWELLMARK BCBS
IA0242024Medicaid
IA24202OtherWELLMARK BCBS
IA1242024Medicaid
IA24202Medicare PIN
IA33946OtherWELLMARK BCBS
IA0242024Medicaid
IA24202OtherWELLMARK BCBS