Individual
ELWOOD DANIEL MOORE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2325 STANTONSBURG RD, GREENVILLE, NC 27834-7534
(252) 847-1550
Mailing address
810 WH SMITH BLVD, GREENVILLE, NC 27834-3763
(252) 757-2663
(252) 317-0829
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
100353
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1274070001
DME MAC JURISDICTION C
—
01
—
200033980
RAILROAD MEDICARE
—
Enumeration date
09/20/2005
Last updated
12/14/2020
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