Provider Demographics
NPI:1942272224
Name:MOORE, KERRY E (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:E
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11700 W 2ND PL STE 450
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1719
Mailing Address - Country:US
Mailing Address - Phone:303-825-1234
Mailing Address - Fax:720-321-8121
Practice Address - Street 1:11700 W 2ND PL STE 450
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1719
Practice Address - Country:US
Practice Address - Phone:303-825-1234
Practice Address - Fax:720-321-8121
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90754824Medicaid
CO90754824Medicaid
CO470758Medicare PIN