Donald R Moore, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

DM038055 Issued in MI

Practice address

25599 Kelly Rd
Suite B
Roseville, MI 48066-4975

Phone

(586) 445-2330

Fax

(586) 445-2352

NPI assigned

Jul 12, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1427073469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 TOWN CENTER DR",
            "address_2": "STE 203",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480841744",
            "telephone_number": "586-445-2330",
            "fax_number": "586-445-2352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25599 KELLY RD",
            "address_2": "SUITE B",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664975",
            "telephone_number": "586-445-2330",
            "fax_number": "586-445-2352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "DONALD",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "DM038055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3232662",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "DM038055",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110131072",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1105016431",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmoore37553@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "25599 Kelly Rd",
            "address_2": "Suite B",
            "city": "Roseville",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480664975",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sabah M Mohammed, MD
• John Montoni, D.P.M.
• Gregory G Montpetit, M.D.
• Michael Joseph Mooney, MA,LLP,CAC,CCS,CCJP
• Andrew William James Moore, DO
• Douglas R Moore, D.O.
• Gennea Nickole Moore, LLP
• Nona Moore
• Courtney Morgott, FNP
• Jessica Jean Morrison

• Internal Medicine Physician in Roseville, MI
• Providers in Roseville, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.