Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | MD09471 | OR |
N | 208000000X | Pediatrician | MD09471 | OR |
NPI | 1346338563 |
---|---|
Provider Name | Mr. Robert Hugh Moore |
First Address | Mcminnville, OR 97128-6818 |
Second Address | Mcminnville, OR 97128-6818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00257004 | BLUE CROSS BLUE SHIELD (01) | OR |
11249 | KAISER (01) | OR |
E79306 | (02) |