Provider Demographics
NPI:1780641779
Name:MOORE, JOYCE GENEVA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:GENEVA
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048
Mailing Address - Country:US
Mailing Address - Phone:913-651-4911
Mailing Address - Fax:
Practice Address - Street 1:1617 RIDGE ROAD
Practice Address - Street 2:RADIOLOGY
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048
Practice Address - Country:US
Practice Address - Phone:913-651-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120034752085R0202X
KS04181492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology