Individual
MICHAEL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1460 G ST, SPRINGFIELD, OR 97477-4112
(541) 726-4400
Mailing address
538 S EDGEWOOD AVE, LA GRANGE, IL 60525-6133
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/18/2018
Last updated
09/18/2018
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