Individual
ANTONIO D MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6728 E GRANDVIEW DR, SCOTTSDALE, AZ 85254-5668
(702) 564-4440
(702) 558-1522
Mailing address
129 W LAKE MEAD PKWY, #B-18, HENDERSON, NV 89015-7055
(702) 564-4440
(702) 558-1522
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA0763
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
615765
—
AZ
Enumeration date
09/21/2010
Last updated
07/21/2022
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