Charles William Moore II, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1029863

Practice address

3475 N Saratoga St
Oak Harbor, WA 98278-1894

Phone

(360) 475-4426

Fax

(360) 475-4344

NPI assigned

Oct 27, 2005

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741824000000",
    "number": "1568452605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3475 N SARATOGA ST",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982784927",
            "telephone_number": "360-257-9927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3475 N SARATOGA ST",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982781894",
            "telephone_number": "360-475-4426",
            "fax_number": "360-475-4344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "CHARLES",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-27",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": "1029863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emmanuel Montenegro
• Kyle Montenegro
• Nayara Martins Montoya
• Moore Healthcare PLLC
• Moore Healthcare PLLC
• Kierston Anna Moran
• Benjamin Franklin Morgan IV, INDEPENDENT DUTY HM
• Meredith Morgan
• Vernon Dale Morgan, M.D.
• Katina Morse

• Physician Assistant in Oak Harbor, WA
• Providers in Oak Harbor, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; 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.