Individual
MICHAEL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCP
Contact information
Practice address
10930 N TATUM BLVD, #103, PHOENIX, AZ 85028-6069
(602) 263-7600
(602) 212-0365
Mailing address
10930 N TATUM BLVD, #103, PHOENIX, AZ 85028-6069
(602) 263-7600
(602) 212-0365
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
02/28/2007
Last updated
07/08/2007
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