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Individual

MR. MICHAEL G MOOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CPO, LPO

Contact information

Practice address
25925 BARTON RD UNIT 36, LOMA LINDA, CA 92354-5601
(503) 367-3848
Mailing address
PO BOX 36, LOMA LINDA, CA 92354-0036
(503) 367-3848

Taxonomy

Speciality
Code
Description
License number
State
222Z00000X
Orthotist
OI00000461
WA
224P00000X
Prosthetist
Primary
PS00000467
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
027853
OR
01
387074301
PC65, FC65, PPO
OR
01
874024000
BCBS PAR, PPP, PC
OR
Enumeration date
02/26/2007
Last updated
07/29/2015
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