Moore, Theodore Bruce
Moore, Theodore Bruce is an individual health care provider with primary practice located at 10833 Le Conte Ave 12-441 Mdcc, Los Angeles CA 90095-3075. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Hematology-Oncology, which is considered as his primary health care specialty. Moore, Theodore Bruce can be contacted via phone (310) 825-6708.Contact Information
Primary practice address
10833 Le Conte Ave 12-441 Mdcc
Los Angeles CA 90095-3075
Phone: (310) 825-6708
Fax: (310) 206-8089
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatric Hematology-Oncology | 2080P0207X | G69308 | California |
Profile Details
| NPI number | 1710091020 |
|---|---|
| LBN Legal business name | Moore, Theodore Bruce |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 17th, 2006 |
| Last updated | Aug 27th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710091020 | NPPES |
| California | MEDICAID | GR0053510 | |
| California | MEDICAID | 00G693080 |
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