Individual
IAN MICHAEL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1370 S WEST TEMPLE, SALT LAKE CITY, UT 84115-5218
(801) 664-2224
Mailing address
2345 E CAMPUS DR, SALT LAKE CITY, UT 84121-3952
(801) 664-2224
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
11/30/2018
Last updated
11/30/2018
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