Provider Demographics
NPI:1952416422
Name:MOORE, THOMAS P (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
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 1:100 ELK RUN DR STE 229
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-9244
Mailing Address - Country:US
Mailing Address - Phone:970-927-3344
Mailing Address - Fax:970-927-9555
Practice Address - Street 1:100 ELK RUN DR STE 229
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-9244
Practice Address - Country:US
Practice Address - Phone:970-927-3344
Practice Address - Fax:970-927-9555
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24599207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01245992Medicaid
COC473158Medicare PIN
E15747Medicare UPIN
CO01245992Medicaid