Individual
DR. MICHAEL R MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1003 SOUTH MAIN STREET, EMININCE, MO 65466-0100
(573) 226-5505
(573) 226-5584
Mailing address
PO BOX 157, ELLINGTON, MO 63638-0157
(573) 663-2313
(573) 663-2322
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R4837
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285957001
MEDICAID (GROUP)
MO
05
—
1336302280
—
MO
01
—
26D2006074
CLIA
MO
01
—
597780303
RH MEDICAID
MO
Enumeration date
07/09/2008
Last updated
07/19/2012
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