Provider Demographics
NPI:1891109963
Name:MOORE, ZANE (DPM)
Entity Type:Individual
Prefix:
First Name:ZANE
Middle Name:
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 1:703 DONAGHEY AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-5107
Mailing Address - Country:US
Mailing Address - Phone:501-327-3668
Mailing Address - Fax:501-327-3664
Practice Address - Street 1:610 HWY 5 N
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-8559
Practice Address - Country:US
Practice Address - Phone:501-327-3668
Practice Address - Fax:501-327-3664
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
AR275213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty