Provider Demographics
NPI:1790852895
Name:MOORE, JOHN CHRISTOPHER (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:MOORE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1719
Mailing Address - Country:US
Mailing Address - Phone:828-350-1880
Mailing Address - Fax:828-252-2272
Practice Address - Street 1:136 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1719
Practice Address - Country:US
Practice Address - Phone:828-350-1880
Practice Address - Fax:828-252-2272
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC467213E00000X, 213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890808JMedicaid
08088OtherBCBS
U91551Medicare UPIN
NC2433652AMedicare PIN