Provider Demographics
NPI:1790734952
Name:MOE, RICHARD M (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:MOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7534 E 2ND ST
Mailing Address - Street 2:102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-4548
Mailing Address - Country:US
Mailing Address - Phone:480-607-3800
Mailing Address - Fax:480-607-3808
Practice Address - Street 1:7534 E 2ND ST
Practice Address - Street 2:102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-4548
Practice Address - Country:US
Practice Address - Phone:480-607-3800
Practice Address - Fax:480-607-3808
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109735207R00000X
AZ20266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100186600BMedicaid
KS100186600DMedicaid
KSP00842632OtherRAILROAD MEDICARE
KS100186600CMedicaid
MO208194118Medicaid
AZ980931Medicaid
MOP00836144OtherRAILROAD MEDICARE
MO208194118Medicaid
KSKA2004026Medicare PIN
KS100186600CMedicaid
KSKA1724026Medicare PIN
MOP00836144OtherRAILROAD MEDICARE
MOMA2491042Medicare PIN