Provider Demographics
NPI:1437597796
Name:MOORE, ZACHARY GLEN (AUD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:GLEN
Last Name:MOORE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHANE CT
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-8517
Mailing Address - Country:US
Mailing Address - Phone:513-256-7915
Mailing Address - Fax:970-829-4410
Practice Address - Street 1:301 WEST MAIN STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-485-6802
Practice Address - Fax:970-829-4410
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO677231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO361075YR4SMedicare PIN