Provider Demographics
NPI:1588604110
Name:MOORE, GEORGE WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WALTER
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1909 214TH STREET SE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021
Mailing Address - Country:US
Mailing Address - Phone:425-420-1650
Mailing Address - Fax:425-420-1651
Practice Address - Street 1:1909 214TH STREET SE
Practice Address - Street 2:SUITE 211
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021
Practice Address - Country:US
Practice Address - Phone:425-420-1650
Practice Address - Fax:425-420-1651
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039482207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0147297OtherLABOR AND INDUSTRY
WA080177572OtherRAILROAD MEDICARE
WAMD00039482OtherSTATE LICENSE NUMBER
WA8275059Medicaid
D42673Medicare UPIN
WA8275059Medicaid