Individual
MR. BRIAN LEE MOORE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6615 BRIARWOOD CIR, WICHITA, KS 67212-2986
(316) 729-4474
(316) 729-4474
Mailing address
6615 BRIARWOOD CIR, WICHITA, KS 67212-2986
(316) 729-4474
(316) 729-4474
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
54974
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
144874
BLUE SHIELD
KS
Enumeration date
05/19/2006
Last updated
07/08/2007
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