Individual
LISA M MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
690 MINOT AVE STE 1, AUBURN, ME 04210-3922
(207) 783-1328
(207) 786-4332
Mailing address
690 MINOT AVE, AUBURN, ME 04210-3922
(207) 783-1328
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
9108417
FL
363A00000X
Physician Assistant
Primary
PA1497
ME
363AS0400X
Surgical Physician Assistant
800
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659456630
—
ME
Enumeration date
10/26/2006
Last updated
11/12/2025
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