Provider Demographics
NPI:1548462385
Name:MOORE, JOHN WILLIAM III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:MOORE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2643 PATTERSON RD STE 605
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-1937
Mailing Address - Country:US
Mailing Address - Phone:970-244-2482
Mailing Address - Fax:970-255-1701
Practice Address - Street 1:2643 PATTERSON RD STE 605
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-1937
Practice Address - Country:US
Practice Address - Phone:970-244-2482
Practice Address - Fax:970-255-1701
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0062442207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200422290AMedicaid
PAF03101Medicare UPIN
IN117700GGGMedicare PIN