Individual
JAMES LEROY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5010 WOOD SHIRE DR, COLUMBIA, MO 65202-6654
(816) 674-5528
Mailing address
5010 WOOD SHIRE DR, COLUMBIA, MO 65202-6654
(816) 674-5528
Taxonomy
Speciality
Code
Description
License number
State
207PS0010X
Sports Medicine (Emergency Medicine) Physician
Primary
113646
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113646
ATHLETIC TRAINER
MO
Enumeration date
05/06/2019
Last updated
05/06/2019
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