Provider Demographics
NPI:1588191977
Name:MOORE, MATTHEW BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRIAN
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10116 W 105TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-5746
Mailing Address - Country:US
Mailing Address - Phone:913-541-0510
Mailing Address - Fax:913-541-1852
Practice Address - Street 1:10116 W 105TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-5746
Practice Address - Country:US
Practice Address - Phone:913-541-0510
Practice Address - Fax:913-541-1852
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022008454207R00000X
KS04-44383207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine