Individual
DAVID MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6282 EDGECREEK LN, COLUMBUS, OH 43231-7645
(810) 728-2686
Mailing address
1401 W NORTH ST, JACKSON, MI 49202-3135
(810) 728-2686
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301108818
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/25/2012
Last updated
04/20/2016
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