Individual
STEVEN ROBERT MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1020 BANDANA BLVD W, SAINT PAUL, MN 55108-5107
(651) 241-9700
(651) 241-9687
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(651) 787-9729
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
30496
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
922585400
—
MN
Enumeration date
02/14/2006
Last updated
09/11/2019
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