Basic Information
| Provider Information | |||||||||
| NPI: | 1134173800 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 WILMINGTON CIR | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 881019311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757491739 | ||||||||
| FaxNumber: | 5757603562 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MT CARMEL WAY | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667627587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202316100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 04-46260 | KS | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 14510A | WY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 39319 | OK | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 91-266 | NM | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 25865 | 05 | NM | MEDICAID |