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Individual

DR. MARTIN RYAN MOON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
4900 HOUSTON RD, FLORENCE, KY 41042-4824
(859) 578-5880
(859) 578-5881
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 578-5800
(589) 578-5881

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
35-070819
OH
208600000X
Surgery Physician
Primary
39444
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
64108491
KY
Enumeration date
08/26/2005
Last updated
11/18/2021
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