DOUGLAS BERNARD MOORE (NPI# 1790853422) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790853422 |
| Entity Type | Individual |
| Full Name | DOUGLAS BERNARD MOORE |
| Credential | PA-C |
| Practice Address |
1304 Fawcett Ave Suite 100 Tacoma WA 98402-1911 |
| Mailing Address |
Po Box 1535 Tacoma WA 98401-1535 |
| Practice Telephone | 2537614200 |
| Practice Fax Number | 2533833553 |
| Mailing Telephone | 2537614200 |
| Mailing Fax Number | 2533833553 |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2017-01-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA10005095 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
PA10005095 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | MEDICARE PIN-TRA PIERCE | 8862652 | 01 |
| WA | RR MEDICARE-TRA | P00428602 | 01 |
| WA | LABOR AND INDUSTRIES-TRA | 0215666 | 01 |
| WA | LABOR AND INDUSTRIES CRIME VICTIMS-TRA | 8943157 | 01 |
| WA | MEDICARE PIN-TRA KING | 8862653 | 01 |
| WA | LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST | 8951854 | 01 |
| WA | LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST | 0249530 | 01 |
| WA | MEDICARE PIN-UNION AVENUE OPEN MRI | 8862654 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669710364 | Douglas Brian Moore | Physical Therapist | 18305 Lyles Dr, Hagerstown, MD 21740-9517 | 2013-01-30 |
| 1528206950 | Douglas Robert Moore | Hearing Instrument Specialist | 14840 Military Trl, Delray Beach, FL 33484-8153 | 2009-01-22 |
| 1578621363 | Douglas William Moore | Dentist | 1011 A Ave W, Oskaloosa, IA 52577-0228 | 2006-12-05 |
| 1679574396 | Douglas Loran Moore | Optometrist | 1902 W 19th St, Suite A, Mountain Grove, MO 65711-1287 | 2005-08-03 |
| 1194729053 | Douglas R Moore | Internal Medicine | 25195 Kelly Rd Ste A, Roseville, MI 48066-4909 | 2005-06-09 |
| 1760008460 | Douglas G Moore | Counselor | 1801 Cherry Hill Rd, Baltimore, MD 21230-3503 | 2020-06-19 |
| 1396064804 | Douglas Boylston Moore IIi | Family Medicine | 901 W Greenwood St, Suite 9, Abbeville, SC 29620-5717 | 2010-05-24 |
| 1427280155 | Douglas John Moore | Psychologist | 6611 Rockside Rd, Suite 215, Independence, OH 44131-2365 | 2009-08-13 |
| 1265696876 | Douglas Richard Moore | Internal Medicine | 7710 Mercy Rd Ste 3000, Omaha, NE 68124-2350 | 2008-07-12 |
| 1417121492 | Douglas William Moore | Obstetrics & Gynecology | 1230 E 6th Ave, Suite 2b, Winfield, KS 67156-3143 | 2008-04-21 |
| Street Address |
1304 FAWCETT AVE SUITE 100 |
| City | TACOMA |
| State | WA |
| Zip Code | 98402-1911 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992703474 | James A. Nudelman | Radiology | 1304 Fawcett Ave, Suite 100, Tacoma, WA 98402-1911 | 2005-07-08 |
| 1962808915 | Joanna Le Nguyen | Physician Assistant | 1304 Fawcett Ave, Suite 100, Tacoma, WA 98402-1911 | 2014-11-18 |
| 1487073979 | Bryce Allen Merritt | Radiology | 1304 Fawcett Ave, Tacoma, WA 98402-1911 | 2014-04-10 |
| 1942503495 | Jennifer M. Witte | Nurse Practitioner | 1304 Fawcett Ave, Suite 100, Tacoma, WA 98402-1911 | 2010-12-06 |
| 1497064612 | Kenneth William Sheil Jr. | Physician Assistant | 1304 Fawcett Ave, Suite 200, Tacoma, WA 98402-1911 | 2010-10-05 |
| 1477866739 | Patrick Nephi Bacon | Radiology | 1304 Fawcett Ave, Suite 100, Tacoma, WA 98402-1911 | 2010-07-15 |
| 1205153418 | Patrick Thomas Flanagan | Radiology | 1304 Fawcett Ave, Suite 100, Tacoma, WA 98402-1911 | 2010-04-27 |
| 1669796223 | Brett Justin Mollard | Radiology | 1304 Fawcett Ave, Suite 100, Tacoma, WA 98402-1911 | 2010-03-24 |
| 1992036008 | Sarah Ann Farley | Radiology | 1304 Fawcett Ave, Suite 100, Tacoma, WA 98402-1911 | 2010-01-29 |
| 1164755039 | Neeraj Lalwani | Radiology | 1304 Fawcett Ave, Suite 100, Tacoma, WA 98402-1911 | 2009-09-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548898638 | Cimberleigh Mclean | Social Worker | 2367 Tacoma Ave S Ofc 211, Tacoma, WA 98402 | 2020-04-01 |
| 1831735802 | Nickolas Justin Wise | Case Manager/Care Coordinator | 1159 Market St, Tacoma, WA 98402 | 2019-11-25 |
| 1841835436 | Michael Roy Bolden | Counselor | 1205 Tacoma Ave S., Suite 1205, Tacoma, WA 98402 | 2019-11-07 |
| 1073024980 | Megan Elizabeth Charron Mourfield | Denturist | 725 St Helens Ave S, Tacoma, WA 98402 | 2017-10-18 |
| 1104367937 | Janelle Santiago | Counselor | Mcdonald Smith Building 110, Uw Autism Center Tacoma, Tacoma, WA 98402 | 2017-03-13 |
| 1891167862 | Tanya Larson Therapy | Community/Behavioral Health | 1102 A. St., Suite 109, (suite 109), Tacoma, WA 98402 | 2015-10-29 |
| 1609242148 | Ashley Lorraine Dahlgren | Peer Specialist | 702 S 14th St., Tacoma, WA 98402 | 2015-08-19 |
| 1821416470 | Nicole Villarreal Mccormick | Acupuncturist | 711 A Ct #100, Tacoma, WA 98402 | 2014-04-01 |
| 1184055824 | Robyn Marie Callahan | Social Worker | 1102 A Street, Suite 202 B, Tacoma, WA 98402 | 2013-12-05 |
| 1679909410 | Kristin Sweet Fischer | Counselor | 708 Market St Unit 411, Tacoma, WA 98402 | 2013-09-25 |
| Find all providers in zip 98402 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609486026 | Joanna Christine Hope | Physician Assistant | 2502 S Union Avenue, Tacoma, WA 98405 | 2020-08-01 |
| 1831663442 | Noah C Chance | Physician Assistant | 9040 Jackson Ave Attn:credentials, Tacoma, WA 98431-4604 | 2019-01-16 |
| 1336618040 | Bailey Bangerter | Physician Assistant | 1901 South Union, A-233, Tacoma, WA 98405 | 2018-11-26 |
| 1518448539 | Kimberly Bui | Physician Assistant | 112 S 8th St Ste 200, Tacoma, WA 98402-5294 | 2018-08-27 |
| 1568942621 | Michelle Lynn Scott | Physician Assistant | 1201 Pacific Ave Ste C6, Tacoma, WA 98402-4393 | 2018-08-17 |
| 1548770670 | Bradley Richard Poe | Physician Assistant | 209 M.l.k. Jr Way, Tacoma, WA 98405 | 2017-10-03 |
| 1326588369 | Alyssa K. Leaning | Physician Assistant | 1724 W Union Ave Ste 100, Tacoma, WA 98405-2099 | 2017-02-23 |
| 1356609218 | Rebecca Ann Sciandra | Physician Assistant | 9040a Jackson Ave Madigan Army Medical Center, Tacoma, WA 98431-7037 | 2012-04-30 |
| 1023392529 | Kristie Michelle Mattern | Physician Assistant | 5427 S Birmingham St, Tacoma, WA 98409-5417 | 2011-10-03 |
| 1700100385 | Colleen Anne Carette | Physician Assistant | 1500 N. Warner St., #1035, Tacoma, WA 98416-1035 | 2010-03-25 |
| Find all providers in TACOMA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.