Individual
MR. NORMAN BLAKE MOORE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169-4810
(803) 935-8538
Mailing address
2890 DAUPHIN ST, MOBILE, AL 36606-2457
(601) 261-3606
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1-090700
AL
367500000X
Certified Registered Nurse Anesthetist
Primary
26371
SC
367500000X
Certified Registered Nurse Anesthetist
901401
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01934777
—
MS
Enumeration date
06/01/2005
Last updated
06/19/2024
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