Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 539 | SC |
NPI | 1326117433 |
---|---|
Provider Name | Richard Hampton Moore |
First Address | North Myrtle Beach, SC 29582-6110 |
Second Address | Little River, SC 29566-7833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 02/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
539 | LICENSE NUMBER (01) | SC |
DEA | BM7187378 (01) | |
PD5391 | (05) | SC |
U84795 | (02) | SC |