Individual
MR. JOHN DOUGLAS MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DIVE IDC
Contact information
Practice address
1004 HERMITAGE RD BLDG 1014, VIRGINIA BEACH, VA 23459-9100
(757) 462-3178
Mailing address
1004 HERMITAGE RD BLDG 1014, VIRGINIA BEACH, VA 23459-9100
(757) 462-3178
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
10/07/2016
Last updated
10/07/2016
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