Individual
WILLIAM C MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
8650 HUDSON BLVD N, LAKE ELMO, MN 55042-9747
(651) 702-7400
Mailing address
14700 28TH AVE N, SUITE 20, PLYMOUTH, MN 55447-4835
(763) 559-3779
(763) 450-3986
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R070888-1
MN
Other
Enumeration date
06/22/2006
Last updated
07/08/2007
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