Provider Demographics
NPI:1295812584
Name:MOORE, DAVID W (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:MOORE
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 1:1221 MADISON ST
Mailing Address - Street 2:SUITE#1523
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3588
Mailing Address - Country:US
Mailing Address - Phone:206-292-6464
Mailing Address - Fax:206-292-6498
Practice Address - Street 1:1221 MADISON ST
Practice Address - Street 2:SUITE#1523
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3588
Practice Address - Country:US
Practice Address - Phone:206-292-6464
Practice Address - Fax:206-292-6498
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020153174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist