Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 944 | WV |
NPI | 1619024759 |
---|---|
Provider Name | Dr. Joan L Moore |
First Address | Frankford, WV 24938-0097 |
Second Address | Frankford, WV 24938-0097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 08/07/2007 |