Individual
MS. PATRICIA LOUISE MOORE
Active
Individual
MS. PATRICIA LOUISE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MEDICAID PROVIDER
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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