Organization
MERWIN B MOORE III MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MERWIN MOORE MD (OWNER)
(870) 424-4710
Entity
Organization
Contact information
Practice address
628 HOSPITAL DR STE E, MOUNTAIN HOME, AR 72653-2953
(870) 424-4710
(870) 424-4780
Mailing address
PO BOX 9178, RUSSELLVILLE, AR 72811-9178
(479) 968-4273
(479) 968-1363
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
2003027560
MO
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0965970002
DME NUMBER
MO
01
—
5G003
ARKANSAS BCBS
AR
Enumeration date
04/07/2006
Last updated
08/26/2008
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