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Individual
GEORGE MOORE
Active
Individual
GEORGE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5711
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057119
—
SC
01
—
P00169807
RAILROAD MEDICARE PTAN
SC
Enumeration date
08/16/2006
Last updated
09/05/2017
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