Individual
BEVERLY DAWN MOOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3333 SILAS CREEK PKWY, WINSTON SALEM, NC 27103-3013
(336) 718-5095
(336) 718-9895
Mailing address
PO BOX 30337, WINSTON SALEM, NC 27130-0337
(336) 718-8592
(336) 718-9269
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
96-00124
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13799
PARTNERS NATIONAL HEALTH
—
01
—
2408394
UNITED HEALTH CARE
—
05
—
5860531
—
VA
01
—
60531
BLUE CROSS/BLUE SHIELD
NC
01
—
6760232005
CIGNA HEALTH CARE
—
05
—
8960531
—
NC
01
—
97953
MEDCOST
—
Enumeration date
10/02/2006
Last updated
12/11/2012
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