Individual
JOHN WILLIAM MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4049 MAIN ST, CHINCOTEAGUE ISLAND, VA 23336-2406
(757) 336-3682
Mailing address
4049 MAIN ST, CHINCOTEAGUE ISLAND, VA 23336-2406
(704) 942-5603
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9801401
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1166L
BC BS NC
NC
05
—
343893A
—
NC
05
—
891166L
—
NC
Enumeration date
07/10/2006
Last updated
02/23/2021
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