Provider Demographics
NPI:1760208235
Name:MOORE, DANIEL CASSADY (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:CASSADY
Last Name:MOORE
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Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:10560 SILVER ORE PT APT 202
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-5331
Mailing Address - Country:US
Mailing Address - Phone:336-465-2114
Mailing Address - Fax:
Practice Address - Street 1:10TH MEDICAL GROUP
Practice Address - Street 2:4102 PINION DRIVE
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840
Practice Address - Country:US
Practice Address - Phone:719-333-5245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant