Provider Demographics
NPI:1548342454
Name:MOORE, WILLIAM L (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4011 TALBOT RD S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5791
Mailing Address - Country:US
Mailing Address - Phone:425-656-5350
Mailing Address - Fax:425-656-5350
Practice Address - Street 1:4011 TALBOT RD S
Practice Address - Street 2:SUITE 220
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5791
Practice Address - Country:US
Practice Address - Phone:425-656-5350
Practice Address - Fax:425-656-5350
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-12228208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00B0238382OtherHMSA - KMS
HI51701203Medicaid
HI00A0238384OtherHMSA - KMWCW
HI51701202Medicaid
HI00B0238382OtherHMSA - KMS
HI56391Medicare ID - Type UnspecifiedKMCWC
HI51701203Medicaid