Individual
IAN JOSEPH MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PEER SUPPORT SPECIAL
Contact information
Practice address
1911 HAZEL AVE, MEDFORD, OR 97501
(541) 734-3951
Mailing address
1911 HAZEL ST., MEDFORD, OR 97501
(541) 734-3951
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
174400000X
Specialist
Primary
—
—
Other
Enumeration date
01/09/2012
Last updated
01/09/2012
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