| Dennis Moore, MD | |
|
1003 Wallace Way, Grandview, WA 98930-8805 | |
| (509) 203-1080 | |
| (509) 203-1077 |
| Full Name | Dennis Moore |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 1003 Wallace Way, Grandview, Washington |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053452250 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 9907 (Nevada) | Secondary |
| 2080A0000X | Pediatrics - Adolescent Medicine | NV 9907 (Nevada) | Secondary |
| 208000000X | Pediatrics | MD61499857 (Washington) | Primary |
| Entity Name | Prosser Public Hospital District Of Benton County |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1306897681 PECOS PAC ID: 6709787872 Enrollment ID: O20040120000974 |
| Mailing Address | Practice Location Address |
|---|---|
| Dennis Moore, MD 1003 Wallace Way, Grandview, WA 98930-8805 Ph: (509) 203-1080 | Dennis Moore, MD 1003 Wallace Way, Grandview, WA 98930-8805 Ph: (509) 203-1080 |
Thatcher Thomas Harlan Felt, Pediatrics Medicare: Medicare Enrolled Practice Location: 1000 Wallace Way, Grandview, WA 98930 Phone: 509-882-3444 Fax: 509-882-1097 | |
Tamera Schille, Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 1000 Wallace Way, Grandview, WA 98930 Phone: 509-882-3444 Fax: 509-882-1097 |