Individual
DEVIN B MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-5400
(417) 820-7129
Mailing address
30 LACRUE AVE, STE 101, GLEN MILLS, PA 19342-1042
(610) 558-4800
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2011030406
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
431560263
TRICARE
MO
01
—
P01036355
RR MCR
MO
Enumeration date
01/06/2012
Last updated
01/12/2021
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