Individual
JERRY MOORE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
417 LIBERTY ST, SPRINGFIELD, MA 01104-3736
(413) 747-0705
(413) 732-7075
Mailing address
417 LIBERTY ST, SPRINGFIELD, MA 01104-3736
(413) 747-0705
(413) 732-7075
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
33527
MA
Other
Enumeration date
09/17/2008
Last updated
09/17/2008
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