Provider Demographics
NPI:1174587034
Name:MOORE, JOYCE (MD)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 E 9TH AVE
Mailing Address - Street 2:710
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3900
Mailing Address - Country:US
Mailing Address - Phone:303-320-7826
Mailing Address - Fax:303-320-7842
Practice Address - Street 1:4500 E 9TH AVE
Practice Address - Street 2:710
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3900
Practice Address - Country:US
Practice Address - Phone:303-320-7826
Practice Address - Fax:303-320-7842
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33282174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF80981Medicare UPIN
COE8929Medicare ID - Type Unspecified