Individual
GRANT K MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 WASON AVENUE, SUITE 100, SPRINGFIELD, MA 01107
(413) 732-7426
(413) 734-2371
Mailing address
100 WASON AVENUE, SUITE 100, SPRINGFIELD, MA 01107
(413) 732-7426
(413) 734-2371
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
2372051
NY
207Y00000X
Otolaryngology Physician
Primary
72182
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02668239
—
NY
05
—
3065898
—
MA
Enumeration date
11/16/2005
Last updated
10/05/2009
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