Individual
MRS. REBEKAH GRIFFIN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1750 W 4TH ST, SUITE 5, MANSFIELD, OH 44906-1770
(419) 526-8444
(419) 529-8617
Mailing address
1957 CLIFFWOOD DR, MANSFIELD, OH 44904-1631
(419) 571-2288
(419) 526-8617
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50-001308
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50-001308
STATE LICENSE
OH
Enumeration date
04/20/2007
Last updated
07/08/2007
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