Individual
SHARILYN K MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1540 LAKE ST S, FOREST LAKE, MN 55025-2628
(651) 464-7100
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
534
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278217100
—
MN
Enumeration date
06/12/2006
Last updated
03/11/2021
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