Provider Demographics
NPI:1801383054
Name:MOORE, DAVID LEON (CCP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEON
Last Name:MOORE
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1830 S ALMA SCHOOL RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3086
Mailing Address - Country:US
Mailing Address - Phone:480-248-3070
Mailing Address - Fax:480-248-3099
Practice Address - Street 1:1830 S ALMA SCHOOL RD STE 108
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3086
Practice Address - Country:US
Practice Address - Phone:480-248-3070
Practice Address - Fax:480-248-3099
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist