Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2013013924 | MO |
N | 207Q00000X | Family Doctor | TEP6294 | NE |
NPI | 1003127085 |
---|---|
Provider Name | Sarah T. Moran |
First Address | Joplin, MO 64803-3810 |
Second Address | Seneca, MO 64865-9247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2010 |
Last Update Date | 29/05/2014 |