Individual
THOMAS B. MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3020 SAINT JOHNS BLVD, STE A, JOPLIN, MO 64804-1564
(417) 781-5387
(417) 781-7174
Mailing address
3020 SAINT JOHNS BLVD, STE A, JOPLIN, MO 64804-1564
(417) 781-5387
(417) 781-7174
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
R3B12
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100164600E
—
KS
05
—
100164600F
—
KS
01
—
1891736815
BLUE CROSS OF KANSAS
KS
05
—
201669439
—
MO
01
—
21620038
BLUE CROSS OF KANSAS CITY
MO
01
—
P00800228
RAIL ROAD MEDICARE
MO
01
—
P00800249
RAIL ROAD MEDICARE
KS
Enumeration date
06/09/2006
Last updated
02/10/2012
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