Provider Demographics
NPI:1790759538
Name:MOORE, JULIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 2027
Mailing Address - Street 2:338 N FRONT ST WPM PATHOLOGY LABORATORY CHARTERED
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-2027
Mailing Address - Country:US
Mailing Address - Phone:785-823-7201
Mailing Address - Fax:785-823-7185
Practice Address - Street 1:338 N FRONT ST
Practice Address - Street 2:WPM PATHOLOGY LABORATORY CHARTERED
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-823-7201
Practice Address - Fax:785-823-7185
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-23163207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS040537Medicare ID - Type Unspecified
E52708Medicare UPIN