Provider Demographics
NPI:1275513319
Name:MOORE, MONICA S (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:S
Last Name:MOORE
Suffix:
Gender:F
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:PO BOX 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-4100
Mailing Address - Fax:520-324-1406
Practice Address - Street 1:9356 E RITA RD
Practice Address - Street 2:SUITE 180
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-6315
Practice Address - Country:US
Practice Address - Phone:520-324-4499
Practice Address - Fax:520-324-4492
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ346730Medicaid
AZE99225Medicare UPIN
AZZ123082Medicare PIN