Provider Demographics
NPI:1992143176
Name:MOORE, ANNA ELISABETH (DPM)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ELISABETH
Last Name:MOORE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1469
Mailing Address - Country:US
Mailing Address - Phone:970-245-3338
Mailing Address - Fax:970-245-9499
Practice Address - Street 1:201 W PARK DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1469
Practice Address - Country:US
Practice Address - Phone:970-245-3338
Practice Address - Fax:970-245-9499
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000761213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist