Individual
MARK MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1221 W 5TH ST, SHERIDAN, WY 82801-2701
(307) 674-4405
Mailing address
1221 W 5TH ST, SHERIDAN, WY 82801-2701
(307) 674-4405
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CPS-014
WY
Other
Enumeration date
01/14/2020
Last updated
02/14/2023
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