Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | CR577 | ME |
Y | 213ER0200X | Radiology | CR577 | ME |
NPI | 1174678122 |
---|---|
Provider Name | Dr. Roy A Moore |
First Address | Windham, ME 04062-5652 |
Second Address | Windham, ME 04062-5652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 30/07/2008 |