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Douglas Bernard Moore

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

1304 Fawcett Ave, Suite 100, Tacoma, WA 98402-1911

PECOS Enrollment

This provider is enrolled in PECOS as DOUGLAS MOORE.

Based on the most recent information from CMS, provider Douglas Bernard Moore is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1790853422
Provider Type
Individual
Full Name
Moore, Douglas Bernard
Credential
PA-C

Gender
Male
Sole Proprietor
No
Enumeration Date
12/1/2006
Last Updated
1/31/2017

Contact Information

Practice Location

1304 Fawcett Ave, Suite 100, Tacoma, WA 98402-1911

(253) 761-4200

(253) 383-3553

Mailing Location

PO Box 1535, Tacoma, WA 98401-1535

(253) 761-4200

(253) 383-3553

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA10005095 Washington
Code 363AM0700X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA10005095 Washington

Provider Identifiers

ID	Description	Issuer
ID 0215666	Description Other	Issuer LABOR AND INDUSTRIES-TRA Washington
ID 8862653	Description Other	Issuer MEDICARE PIN-TRA KING Washington
ID 8943157	Description Other	Issuer LABOR AND INDUSTRIES CRIME VICTIMS-TRA Washington
ID P00428602	Description Other	Issuer RR MEDICARE-TRA Washington
ID 8862652	Description Other	Issuer MEDICARE PIN-TRA PIERCE Washington
ID 8862654	Description Other	Issuer MEDICARE PIN-UNION AVENUE OPEN MRI Washington
ID 0249530	Description Other	Issuer LABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST Washington
ID 8951854	Description Other	Issuer LABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST Washington

Douglas Bernard Moore

PECOS Enrollment

Profile Details

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