Individual
JOHN THOMAS MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2154 SUTTON HOOTEN LN, LA GRANGE, NC 28551-8252
(252) 566-3298
(252) 566-2829
Mailing address
2154 SUTTON HOOTEN LN, LA GRANGE, NC 28551-8252
(252) 521-2957
(252) 566-2829
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
100460
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2335762
MEDICARE GROUP PROVIDER NUMBER
NC
01
—
2763714A
MEDICARE INDIVIDUAL PROVIDER NUMBER
NC
Enumeration date
08/31/2005
Last updated
02/17/2010
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