Individual
DR. BRIAN KEITH MOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2624 9TH AVE S, FARGO, ND 58103-2350
(701) 298-4500
Mailing address
1563 11TH AVE E, WEST FARGO, ND 58078-5204
(218) 779-0230
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
480
ND
Other
Enumeration date
12/09/2010
Last updated
02/21/2013
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