Provider Demographics
NPI:1972607067
Name:MOORE, JOSEPH PATRICK (MD)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2920 N CASCADE AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6265
Mailing Address - Country:US
Mailing Address - Phone:719-636-1201
Mailing Address - Fax:719-636-1326
Practice Address - Street 1:2222 NORTH NEVADA AVENUE
Practice Address - Street 2:SUITE 5001
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6865
Practice Address - Country:US
Practice Address - Phone:719-636-1201
Practice Address - Fax:719-636-1326
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO37170207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO607324OtherBCBS
CO01371707Medicaid
COC418928Medicare PIN
CO01371707Medicaid