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Individual
JOHN B MOORE IV
Active
Individual
JOHN B MOORE IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2086S0105X
Surgery of the Hand (Surgery) Physician
0420320
KS
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
0420320
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100205260A
—
KS
01
—
10226021
BLUE CROSS
KS
01
—
563754
UNITED HEALTH CARE
KS
Enumeration date
11/08/2005
Last updated
08/03/2011
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