Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 2710 | NV |
NPI | 1205895984 |
---|---|
Provider Name | Kent Moore |
First Address | Reno, NV 89502-1304 |
Second Address | Sparks, NV 89434-9641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 04/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E44161 | (02) | NV |