Provider Demographics
NPI:1942480066
Name:MOORE, JULIE RACHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:RACHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:RACHELLE
Other - Last Name:MADRID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1920 N HIGLEY RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-1623
Mailing Address - Country:US
Mailing Address - Phone:480-543-6700
Mailing Address - Fax:480-543-6725
Practice Address - Street 1:1920 N HIGLEY RD
Practice Address - Street 2:SUITE 206
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-1623
Practice Address - Country:US
Practice Address - Phone:480-543-6700
Practice Address - Fax:480-543-6725
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3719363AM0700X, 363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ135178Medicare PIN