Organization
CANEBRAKE MEDICAL MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERRE M. MOORE CRNP (CRNP)
(334) 289-9408
Entity
Organization
Contact information
Practice address
123 E CAPITOL ST, DEMOPOLIS, AL 36732-2218
(334) 289-9408
Mailing address
123 E CAPITOL ST, DEMOPOLIS, AL 36732-2218
(334) 289-9408
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11061
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129958
—
AL
Enumeration date
05/10/2011
Last updated
10/14/2011
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