Provider Demographics
NPI:1932136942
Name:MOORER, LEE A (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:A
Last Name:MOORER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 ELBERT ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2411
Mailing Address - Country:US
Mailing Address - Phone:303-808-1099
Mailing Address - Fax:866-284-6194
Practice Address - Street 1:422 ELBERT ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2411
Practice Address - Country:US
Practice Address - Phone:720-524-8949
Practice Address - Fax:866-842-8782
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40884208100000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43787266Medicaid
COH46745Medicare UPIN