Individual
MR. MICHAEL RILEY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BOC P. ABC C.F.O.
Contact information
Practice address
615 W GROVE ST, EL DORADO, AR 71730-4413
(870) 862-0241
(903) 838-8094
Mailing address
615 W GROVE ST, EL DORADO, AR 71730-4413
(870) 862-0241
(903) 838-8094
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
OPP00120
AR
224P00000X
Prosthetist
Primary
OPP00120
AR
Other
Enumeration date
01/18/2007
Last updated
01/21/2009
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