Individual
BRIAN G MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 I ST FL 2, LA PORTE, IN 46350-5533
(219) 575-6060
(219) 575-6004
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01040502A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200086240A
—
IN
Enumeration date
08/22/2006
Last updated
01/31/2024
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