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Individual

PAUL ROBERT MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RN, CRNA

Contact information

Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 609-2000
Mailing address
1515 E 20TH ST STE A, FARMINGTON, NM 87401-9039
(505) 326-6400
(505) 326-4606

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R1778687
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1558686253
NM
05
ENROLLED
MN
Enumeration date
04/06/2010
Last updated
08/11/2010
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