Provider Demographics
NPI:1336220748
Name:MOORE, MERIJEANNE ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:MERIJEANNE
Middle Name:ANNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7841 TALISMAN RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-3327
Mailing Address - Country:US
Mailing Address - Phone:074-411-1609
Mailing Address - Fax:
Practice Address - Street 1:7841 TALISMAN RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-3327
Practice Address - Country:US
Practice Address - Phone:074-411-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA26092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E84791Medicare UPIN
0000BKBKBMedicare PIN