Individual
JOHN LEWIS MOORE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1105 RAYMOND AVE, SAINT PAUL, MN 55108-1922
(651) 706-9918
Mailing address
1105 RAYMOND AVE, SAINT PAUL, MN 55108-1922
(651) 706-9918
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
W000-059-784-000
MN
Other
Enumeration date
08/26/2024
Last updated
08/26/2024
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