Individual
MARK GREGORY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2000 S PALESTINE ST, ATHENS, TX 75751-5610
(903) 677-1000
(903) 677-5586
Mailing address
PO BOX 2127, ATHENS, TX 75751-7127
(903) 677-1000
(903) 677-5586
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
548063
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0026460-01
—
TX
Enumeration date
10/21/2005
Last updated
04/06/2010
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