Provider Demographics
NPI:1396010872
Name:MOORE, PAIGE LEE (MD)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:LEE
Other - Last Name:BLANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2025 SOQUEL AVE.
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1323
Mailing Address - Country:US
Mailing Address - Phone:831-479-6603
Mailing Address - Fax:
Practice Address - Street 1:550 SO. GREEN VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3053
Practice Address - Country:US
Practice Address - Phone:831-458-5865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine