Individual
DR. HENRY R MOORE III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3240
(217) 383-4597
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801-2529
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036119986
IL
208600000X
Surgery Physician
MD036123
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036119986
—
IL
01
—
0533210001
DMERC
—
Enumeration date
08/22/2007
Last updated
03/31/2022
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