Individual
MICHAEL J MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
305 S STATE ST, ABERDEEN, SD 57401-4527
(605) 622-5000
(605) 622-5255
Mailing address
PO BOX 4450, ABERDEEN, SD 57402-4450
(605) 622-5000
(605) 622-5255
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
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