Provider Demographics
NPI:1104141662
Name:MOORE, BRYAN J (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:J
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N ST ANDREWS PL APT 1/2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-2511
Mailing Address - Country:US
Mailing Address - Phone:540-998-3646
Mailing Address - Fax:
Practice Address - Street 1:INTOUCH HEALTH / C3O TELEMEDICINE
Practice Address - Street 2:7402 HOLLISTER AVENUE
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93117
Practice Address - Country:US
Practice Address - Phone:805-562-8686
Practice Address - Fax:805-456-1796
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-28
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-126442084N0400X
TN600602084N0400X
NJ25MA100408002084N0400X
IN01086940A2084N0400X
MS272872084N0400X
MI43015003172084N0400X
WI67009-202084N0400X
MN614732084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology