Individual
MICHAEL J MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R025845
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002489
BLUE CROSS
SD
01
—
035918
CRNA CERTIFICATION
SD
05
—
5752422
—
SD
01
—
R35918
DAKOTACARE
SD
Enumeration date
11/13/2006
Last updated
02/27/2008
Update your record
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