Provider Demographics
NPI:1063412070
Name:MOORE, JOHN ERIC (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:MOORE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:40220 SADDLEBROOK ST
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6100
Mailing Address - Country:US
Mailing Address - Phone:951-600-9640
Mailing Address - Fax:
Practice Address - Street 1:55 W TIETAN ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4498
Practice Address - Country:US
Practice Address - Phone:509-525-3720
Practice Address - Fax:509-522-1593
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2020-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01022001116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine