Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 13592 | MO |
Y | 213EG0000X | General Practice | 13592 | MO |
NPI | 1003905910 |
---|---|
Provider Name | Dr. Ernest Paul Moore |
First Address | New Melle, MO 63365-0218 |
Second Address | New Melle, MO 63365-0218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |