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Individual

RICHARD C MOAK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
110 29TH AVE N STE 202, NASHVILLE, TN 37203-1448
(615) 327-4304
Mailing address
110 29TH AVE N STE 202, NASHVILLE, TN 37203-1448

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3015765
KY
367500000X
Certified Registered Nurse Anesthetist
78185
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100488
AL
05
3600260
TN
01
620931432
TRICARE REGION SOUTH
TN
Enumeration date
01/02/2008
Last updated
04/20/2021
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