Individual
ROGER T MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 N NAPPANEE ST, ELKHART, IN 46514-1957
(574) 522-0265
(574) 293-2855
Mailing address
111 N NAPPANEE STREET, ELKHART, IN 46514
(574) 522-0265
(574) 293-2855
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01058554A
IN
Other
Enumeration date
04/21/2006
Last updated
07/08/2007
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