Individual
WAYNE E MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
901 LINCOLNWAY, STE 304, LAPORTE, IN 46350
(219) 362-8523
(219) 324-9396
Mailing address
P.O. BOX 1690, LAPORTE, IN 46352-1690
(219) 326-2312
(219) 326-2584
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
IN01038003A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01038003
LICENSE NUMBER
—
01
—
01038003B
CSR
IN
05
—
100367770A
—
IN
Enumeration date
08/04/2006
Last updated
03/07/2023
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