Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | A22449 | CA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD25612 | OR |
NPI | 1225117625 |
---|---|
Provider Name | Dr. Barbara Ellen Moore |
First Address | Roseburg, OR 97470-8953 |
Second Address | Roseburg, OR 97470-8953 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A224490 | (05) | CA |
F16511 | (02) | |
O27954 | (05) | OR |