Provider Demographics
NPI:1104948249
Name:MOORE, DAVID RICHARD (MS, BC-HIS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
Last Name:MOORE
Suffix:
Gender:M
Credentials:MS, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17309 139TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8571
Mailing Address - Country:US
Mailing Address - Phone:425-487-3942
Mailing Address - Fax:425-489-3092
Practice Address - Street 1:17309 139TH AVE NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8571
Practice Address - Country:US
Practice Address - Phone:425-487-3942
Practice Address - Fax:425-489-3092
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA00003843237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAHA00003843OtherHEARING INST FITTER DISP