Individual
KENNETH EDWARD MOORE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
MCGUIRE VAMC, 1201 BROAD ROCK RD, RICHMOND, VA 23249
(804) 675-5027
Mailing address
10064 BEECHWOOD DR, MECHANICSVILLE, VA 23116-2730
(804) 730-7898
Taxonomy
Speciality
Code
Description
License number
State
2081P0004X
Spinal Cord Injury Medicine Physician
Primary
0101045616
VA
Other
Enumeration date
05/04/2006
Last updated
07/08/2007
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