Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 009600648 | NC |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 9600648 | NC |
NPI | 1336141258 |
---|---|
Provider Name | Richard S. Moore JR. |
First Address | Wilmington, NC 28412-2489 |
Second Address | Wilmington, NC 28412-2489 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 23/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009600648 | MEDICAL LICENSE (01) | NC |
8910349 | (05) | NC |
G48709 | (02) | NC |