Individual
DR. PATRICIA A MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
52303 EMMONS RD, STE A7, SOUTH BEND, IN 46637-4293
(574) 277-5390
(574) 277-6340
Mailing address
52303 EMMONS RD, STE A7, SOUTH BEND, IN 46637-4293
(574) 277-5390
(574) 277-6340
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000521A
IN
213E00000X
Podiatrist
5901001129
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100223850A
—
IN
05
—
1470280
—
MI
Enumeration date
07/20/2005
Last updated
12/15/2017
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