Organization
MB MOORE MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MB MOORE (PHYSICIAN OWNER)
(573) 785-4731
Entity
Organization
Contact information
Practice address
223 PHYSICIANS PARK, POPLAR BLUFF, MO 63901-3956
(573) 785-4731
Mailing address
PO BOX 3907, POPLAR BLUFF, MO 63902-3907
(573) 785-4601
(573) 686-0178
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
627234909
MEDICAID DME
MO
Enumeration date
06/26/2008
Last updated
06/26/2008
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