Provider Demographics
NPI:1376530964
Name:MOORE, THOMAS O'NEAL (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:O'NEAL
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:377 MDG
Mailing Address - Street 2:2050A SECOND ST SE
Mailing Address - City:KIRTLAND AFB
Mailing Address - State:NM
Mailing Address - Zip Code:87117-5522
Mailing Address - Country:US
Mailing Address - Phone:505-846-1186
Mailing Address - Fax:
Practice Address - Street 1:377 MDG
Practice Address - Street 2:2050A SECOND ST SE
Practice Address - City:KIRTLAND AFB
Practice Address - State:NM
Practice Address - Zip Code:87117-5522
Practice Address - Country:US
Practice Address - Phone:505-846-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2009-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01058273A2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine