Provider Demographics
NPI:1699725937
Name:MOORE, GREG R (AUD, CCCA)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:R
Last Name:MOORE
Suffix:
Gender:M
Credentials:AUD, CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14633 N DEL WEBB BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-2144
Mailing Address - Country:US
Mailing Address - Phone:602-549-2259
Mailing Address - Fax:
Practice Address - Street 1:14633 N DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-2144
Practice Address - Country:US
Practice Address - Phone:602-549-2259
Practice Address - Fax:623-825-6632
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA852231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ840018Medicaid
AZZNGBBTMedicare PIN
AZR15863Medicare UPIN