Individual
PAMELA M MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
611 W. PARK ST., CARDIOLOGY, URBANA, IL 61801-2500
(217) 904-7000
(217) 904-7742
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
(217) 383-4752
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
RN81005
AZ
363LA2200X
Adult Health Nurse Practitioner
Primary
209-006880
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102542
RR MC GRP
AZ
01
—
103086
RR MC PIN
AZ
01
—
103086
MC COCHISE
—
01
—
103087
RR MC PIN
AZ
01
—
103087
MC PIMA
—
01
—
1Z1408
INTERGROUP HEALTHNET
—
01
—
300051634
HEALTH PLAN AHP
AZ
01
—
300051634
MARICOPA FOUND
—
01
—
448664
MERCY CARE
—
05
—
448664
—
AZ
01
—
500005593
TRAVELERS MC
—
01
—
AZ0819900
BCBS
AZ
Enumeration date
08/23/2006
Last updated
05/28/2014
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