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Individual
DEBORAH D MOORE
Active
Individual
DEBORAH D MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002158
GA
363AM0700X
Medical Physician Assistant
002158
GA
363AS0400X
Surgical Physician Assistant
002158
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000662
—
GA
01
—
DC4061
RAILROAD MEDICARE
GA
01
—
P00168580
RAILROAD MEDICARE
GA
Enumeration date
08/30/2005
Last updated
04/13/2020
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