Individual
JOHN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
89 SUMMERS WAY, ROANOKE, VA 24019-8291
(540) 992-1251
Mailing address
5360 SILVER FOX RD, ROANOKE, VA 24018-8741
(540) 529-5302
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101-232374
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006729134
—
VA
05
—
006733867
—
VA
Enumeration date
02/13/2006
Last updated
12/09/2013
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