Provider Demographics
NPI:1710164587
Name:MOORE, ANDREA R (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3810 S 6TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4760
Mailing Address - Country:US
Mailing Address - Phone:458-232-1854
Mailing Address - Fax:458-232-1855
Practice Address - Street 1:3810 S 6TH ST STE 210
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4760
Practice Address - Country:US
Practice Address - Phone:458-232-1854
Practice Address - Fax:458-232-1855
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORPA150607208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery