Individual
DR. JOHN RUSSELL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19001 E 48TH ST S, INDEPENDENCE, MO 64055
(816) 836-8831
(816) 795-0144
Mailing address
19001 E 48TH ST S, INDEPENDENCE, MO 64055
(816) 836-8831
(816) 795-0144
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
2001004851
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204467005
—
MO
Enumeration date
05/10/2006
Last updated
09/21/2014
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