Individual
MS. PATRICIA LOUISE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MEDICAID PROVIDER
Contact information
Practice address
1453 S. BANCROFT, INDIANAPLIS, IN 46203-3709
(317) 410-7339
Mailing address
3601 DECAMP DR, INDIANAPOLIS, IN 46226-6040
(317) 410-7339
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
200974970A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
304563020A
MEDICARE
IN
Enumeration date
11/24/2010
Last updated
05/04/2011
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