Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2788 | CO |
NPI | 1508878463 |
---|---|
Provider Name | Dr. Steven Roger Mooring |
First Address | Pueblo, CO 81008-1672 |
Second Address | Pueblo, CO 81008-1672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 22/03/2011 |