Provider Demographics
NPI:1235131574
Name:MOORE, CHRISTINE LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:LEE
Other - Last Name:LEMAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-0193
Mailing Address - Country:US
Mailing Address - Phone:816-322-0701
Mailing Address - Fax:816-322-2035
Practice Address - Street 1:402 W PINE ST
Practice Address - Street 2:STE K
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9075
Practice Address - Country:US
Practice Address - Phone:816-322-0701
Practice Address - Fax:816-322-2035
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8J20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242670602Medicaid
MO15229013OtherBCBSKC
MOE43575Medicare UPIN
MO242670602Medicaid
MOI300958Medicare PIN
MOI300958Medicare PIN