Individual
MR. DERRICK MONTEREY MOORE SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8325 POPLAR SPRINGS DR LOT 55, MERIDIAN, MS 39305-9243
(601) 681-4582
(601) 681-9642
Mailing address
8325 POPLAR SPRINGS DR LOT 55, MERIDIAN, MS 39305-9243
(601) 681-4582
(601) 681-9642
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
9205865
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02926254
—
MS
Enumeration date
08/08/2008
Last updated
08/08/2008
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