Provider Demographics
NPI:1255228490
Name:SHANE MOORE DPM PC
Entity type:Organization
Organization Name:SHANE MOORE DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-241-9848
Mailing Address - Street 1:13660 N 94TH DR STE D1
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4275
Mailing Address - Country:US
Mailing Address - Phone:623-974-0522
Mailing Address - Fax:623-933-5787
Practice Address - Street 1:865 S WATSON RD STE 205
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-3470
Practice Address - Country:US
Practice Address - Phone:623-974-0522
Practice Address - Fax:623-933-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty