Individual
MR. FREDERICK EARL MOORE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
907 MISSISSIPPI AVE, GREENWOOD, MS 38930-5220
(662) 458-1982
Mailing address
907 MISSISSIPPI AVE, GREENWOOD, MS 38930-5220
(662) 458-1982
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
347E00000X
Transportation Broker
—
—
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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