Provider Demographics
NPI:1053418921
Name:MOORE, MARTHA JANE (MD-MPH)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:JANE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD-MPH
Other - Prefix:DR
Other - First Name:M JANE
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD-MPH
Mailing Address - Street 1:3223 E PALMER WASILLA HWY STE 4
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7277
Mailing Address - Country:US
Mailing Address - Phone:907-631-6300
Mailing Address - Fax:907-631-6314
Practice Address - Street 1:3223 E PALMER WASILLA HWY STE 4
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7277
Practice Address - Country:US
Practice Address - Phone:907-631-6300
Practice Address - Fax:907-631-6314
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6678207QA0401X
AK3944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD8920Medicaid