Individual
TIM I MOOMAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5000
Mailing address
75 REMIT DR, #1367, CHICAGO, IL 60675-1367
(866) 916-5259
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
COA.17111-NP
OH
Other
Enumeration date
02/18/2015
Last updated
02/18/2015
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