Individual
DAVID MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6173 BAYOU TRL, SAUGATUCK, MI 49453-9671
(244) 202-7202
Mailing address
6173 BAYOU TRL, SAUGATUCK, MI 49453-9671
(244) 202-7202
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036053464
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360534641
—
IL
Enumeration date
03/31/2006
Last updated
04/08/2020
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