Provider Demographics
NPI:1942292990
Name:MOORE, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:M
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6400 PROSPECT AVE
Mailing Address - Street 2:SUITE 238
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1100
Mailing Address - Country:US
Mailing Address - Phone:816-363-4114
Mailing Address - Fax:816-363-5568
Practice Address - Street 1:6400 PROSPECT AVE
Practice Address - Street 2:SUITE 238
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1100
Practice Address - Country:US
Practice Address - Phone:816-363-4114
Practice Address - Fax:816-363-5568
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR3B83207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO09343022OtherBCBS INDIVIDUAL ID
MO09343022OtherBCBS INDIVIDUAL ID
MOT814935Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID