Individual
DR. RENATA CHARISSA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1990 E LAKE SHORE DR, DECATUR, IL 62521-3811
(217) 464-2900
(217) 464-2909
Mailing address
210 W MCKINLEY AVE, SUITE 1, DECATUR, IL 62526-5858
(217) 876-6600
(217) 876-6606
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
036093129
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093129
—
IL
Enumeration date
09/29/2006
Last updated
02/12/2014
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