Individual
RICHARD L. MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6402 ODANA RD, MADISON, WI 53719-1123
(608) 288-9040
(608) 288-9042
Mailing address
6402 ODANA ROAD, MADISON, WI 53719
(608) 288-9040
(608) 288-9042
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
13990-020
WI
2084P0804X
Child & Adolescent Psychiatry Physician
13990-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13990-020
STATE OF WISCONSIN LICENSE #
WI
Enumeration date
07/23/2008
Last updated
07/23/2008
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