Individual
RANDALL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6760 MISSION RD, EVERSON, WA 98247-9749
(360) 966-2106
Mailing address
23520 109TH AVENUE, MAPLE RIDGE, BRITISH COLUMBIA V21 1-A8
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00030411
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8248239
—
WA
Enumeration date
12/12/2006
Last updated
07/08/2007
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