Individual
MR. GASTON A MOORE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
1702 W TUCKEY LN, PHOENIX, AZ 85015-1715
(602) 518-5910
Mailing address
1702 W TUCKEY LN, PHOENIX, AZ 85015-1715
(602) 518-5910
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
LP039366
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LP039366
LPN
AZ
Enumeration date
10/08/2009
Last updated
10/08/2009
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