Provider Demographics
NPI:1063411544
Name:MOIR, GEORGE DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DOUGLAS
Last Name:MOIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G.
Other - Middle Name:DOUGLAS
Other - Last Name:MOIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:810 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3402
Mailing Address - Country:US
Mailing Address - Phone:760-741-9318
Mailing Address - Fax:760-741-9484
Practice Address - Street 1:810 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3402
Practice Address - Country:US
Practice Address - Phone:760-741-9318
Practice Address - Fax:760-741-9484
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36411207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGG654ZOtherMEDICARE PTAN
CA00C364110Medicaid
CAWC36411AMedicare PIN
A36256Medicare UPIN
CA00C364110Medicaid