Provider Demographics
NPI:1184647349
Name:MOORE, DAVID MICHAEL
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60185
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93386-0185
Mailing Address - Country:US
Mailing Address - Phone:661-872-1000
Mailing Address - Fax:661-873-8304
Practice Address - Street 1:2601 OSWELL ST
Practice Address - Street 2:STE 101
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3156
Practice Address - Country:US
Practice Address - Phone:661-872-1000
Practice Address - Fax:661-873-8304
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G545660Medicaid
00G545660Medicare ID - Type Unspecified
CA00G545660Medicaid