Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ethan Thomas Moore, MD

Individual provider Plastic Surgery within the Head & Neck (Otolaryngology) Physician · NPI 1619810926

Ethan Thomas Moore, MD is a Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Rochester, Minnesota. Licensed in Minnesota. Registered with an NPI since 2026.

Licensed in
MN
In the registry since
2026
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

200 1st St SW
Rochester, MN 55905-0002
Phone: (507) 284-2511
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Plastic Surgery within the Head & Neck (Otolaryngology) Physician (primary) Taxonomy 207YX0007X · Licence 36291 (MN)

Record details

NPI number1619810926
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 11, 2026
Last updated in NPPESApril 27, 2026
Certification dateApril 27, 2026
Mailing addressPo Box 860912, Minneapolis, MN 55486-0912

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