Provider Demographics
NPI:1922306760
Name:MOORE, DAVID JONATHAN (CSFA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JONATHAN
Last Name:MOORE
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-0602
Mailing Address - Country:US
Mailing Address - Phone:970-629-2135
Mailing Address - Fax:
Practice Address - Street 1:674 MESA CT
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-2529
Practice Address - Country:US
Practice Address - Phone:970-629-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant