Provider Demographics
NPI:1356326888
Name:MOORE, ALISON MERSER (PA)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:MERSER
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4496
Mailing Address - Country:US
Mailing Address - Phone:303-449-0517
Mailing Address - Fax:303-449-0634
Practice Address - Street 1:1949 PEARL ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4496
Practice Address - Country:US
Practice Address - Phone:303-449-0517
Practice Address - Fax:303-449-0634
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1636363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO477618Medicare ID - Type Unspecified
P70733Medicare UPIN