Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 33095 | CO |
N | 225400000X | Rehabilitation Practitioner | G85748 | CA |
NPI | 1235132978 |
---|---|
Provider Name | Dr. Michael Roy Moore |
First Address | Billings, MT 59101-0703 |
Second Address | Billings, MT 59101-0703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2005 |
Last Update Date | 06/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G857480 | (05) | CA |
F80656 | (02) | CA |