Provider Demographics
NPI:1659618510
Name:MOURE, ANTONIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:A
Last Name:MOURE
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 1:1521 2ND AVE
Mailing Address - Street 2:APARTMENT 1400
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-4500
Mailing Address - Country:US
Mailing Address - Phone:206-257-0233
Mailing Address - Fax:
Practice Address - Street 1:1521 2ND AVE
Practice Address - Street 2:APARTMENT 1400
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-4500
Practice Address - Country:US
Practice Address - Phone:206-257-0233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1749207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN0005598OtherDPS
TXBM0249070OtherDEA