Provider Demographics
NPI:1760639009
Name:JOHN C MOORE MD PC
Entity Type:Organization
Organization Name:JOHN C MOORE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAGGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-234-1895
Mailing Address - Street 1:88 INVERNESS CIR E
Mailing Address - Street 2:K102
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5304
Mailing Address - Country:US
Mailing Address - Phone:702-234-1895
Mailing Address - Fax:
Practice Address - Street 1:88 INVERNESS CIR E
Practice Address - Street 2:K102
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5304
Practice Address - Country:US
Practice Address - Phone:702-234-1895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24909207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty