Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 22004 | MS |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 254426 | NY |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 31773 | AL |
NPI | 1962679241 |
---|---|
Provider Name | Paul H Moore III |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2008 |
Last Update Date | 11/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05182213 | (05) | MS |