Individual
STEPHEN D MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
206 PORR DR, RUIDOSO, NM 88345-6713
(575) 630-0571
(575) 630-0574
Mailing address
PO BOX 1044, ALTO, NM 88312-1044
(575) 336-1006
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/05/2010
Last updated
08/05/2010
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