Individual
MR. THOMAS GLENNON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
6475 WARRIOR WAY, BLDG. 1938, HILL AFB, UT 84056-5974
(801) 777-0658
Mailing address
4296 APPOMATTOX CIR APT A, HILL AFB, UT 84056-1572
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
05/04/2009
Last updated
05/04/2009
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