Individual
MICHAEL T MOORE
Active
Individual
MICHAEL T MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
004400
CT
363AS0400X
Surgical Physician Assistant
004400
CT
363AS0400X
Surgical Physician Assistant
Primary
PA.0007220
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/25/2018
Last updated
04/25/2022
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