Individual
MARCUS A MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6770 DIXIE HWY STE 200, CLARKSTON, MI 48346-2089
(248) 625-2621
(248) 625-8938
Mailing address
5360 WILD DAISY CT, CLARKSTON, MI 48346-4984
(248) 921-9524
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101015942
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5101015942
PHYSICIAN LICENSE
MI
01
—
5315024072
CONTROLLED SUBSTANCE
MI
Enumeration date
07/19/2006
Last updated
07/08/2007
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