Individual
TERRY J MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1821 S WEBSTER AVE, GREEN BAY, WI 54301-2253
(920) 496-4700
(920) 496-4705
Mailing address
1821 S WEBSTER AVE, GREEN BAY, WI 54301-2253
(920) 496-4700
(920) 496-4705
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
41170
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32575400
—
WI
Enumeration date
08/01/2006
Last updated
04/04/2013
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