Individual
DR. STEPHEN G MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2749 E COVENANTER DR, BLOOMINGTON, IN 47401-5454
(812) 332-2265
(812) 334-0853
Mailing address
2749 E COVENANTER DR, BLOOMINGTON, IN 47401-5454
(812) 332-2265
(812) 334-0853
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01044533A
IN
Other
Enumeration date
11/30/2010
Last updated
11/30/2010
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