Provider Demographics
NPI:1295766368
Name:REESER MOORE, KRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:
Last Name:REESER MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:ANN
Other - Last Name:REESER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6200 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3529
Mailing Address - Country:US
Mailing Address - Phone:520-469-8014
Mailing Address - Fax:520-469-8009
Practice Address - Street 1:6200 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3529
Practice Address - Country:US
Practice Address - Phone:520-469-8014
Practice Address - Fax:520-469-8009
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28756207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ877471OtherAHCCCS ID #
AZ877471OtherAHCCCS ID #
AZ82132Medicare ID - Type Unspecified
AZ28019Medicare PIN