Provider Demographics
NPI:1235182346
Name:MOORE, CURTIS ALAN (MD)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:ALAN
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 1:18695 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2738
Mailing Address - Country:US
Mailing Address - Phone:913-782-3322
Mailing Address - Fax:913-782-1264
Practice Address - Street 1:18695 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2738
Practice Address - Country:US
Practice Address - Phone:913-782-3322
Practice Address - Fax:913-782-1264
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100348200BMedicaid
C51949Medicare UPIN
KS100348200BMedicaid