Individual
FREEMAN MARK MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
225 MEMORIAL DR, BERLIN, WI 54923-1243
(920) 361-1313
Mailing address
1501 S LUTZ DR, APPLETON, WI 54914-5550
(920) 832-1006
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
Primary
18406
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31154500
—
WI
Enumeration date
06/23/2006
Last updated
07/08/2007
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