Individual
MARK C MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1313 FISH HATCHERY RD, DEAN MEDICAL CENTER, MADISON, WI 53715-1911
(608) 252-8000
(608) 252-8245
Mailing address
1313 FISH HATCHERY RD, DEAN MEDICAL CENTER, MADISON, WI 53715-1911
(608) 252-8000
(608) 252-8245
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
32945-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2901
DEAN HEALTH INSURANCE
WI
05
—
31824100
—
WI
Enumeration date
06/08/2006
Last updated
05/08/2008
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