Individual
DR. SCOTT R. MOOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
940 W MOUNT VERNON ST, NIXA, MO 65714-9609
(417) 724-5200
(417) 724-5203
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
113804
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209747302
—
MO
Enumeration date
11/20/2006
Last updated
05/09/2013
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