Individual
MARK S MOORE
Active
Individual
MARK S MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
112240
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100180650B
OK CAID
—
01
—
100343220A
KS CAID
—
01
—
112240
MEDICAL LICENSE
MO
01
—
115634
MO BLUE
—
05
—
248699902
—
MO
01
—
451258
HLTLINK
—
05
—
83787844
—
CO
Enumeration date
08/18/2006
Last updated
11/05/2020
Update your record
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