Individual
JOHN MOORE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1411 W BADDOUR PKWY, LEBANON, TN 37087-2513
(615) 256-1064
Mailing address
PO BOX 207, MEMPHIS, TN 38101-0207
(813) 287-5718
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
8827
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3601010
—
TN
Enumeration date
03/10/2006
Last updated
07/08/2007
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