Individual
COLLEEN JOHNSON MOORE
Active
Individual
COLLEEN JOHNSON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
036113689
IL
2086S0129X
Vascular Surgery Physician
2004001641
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113689
—
IL
01
—
F400526418
MEDICARE PIN
IL
Enumeration date
11/07/2005
Last updated
07/27/2023
Update your record
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