Healthcare Provider Details

I. General information

NPI: 1235218850
Provider Name (Legal Business Name): FRANCIS BERNARD MOORE P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S MOUNTAIN AVE
SPRINGERVILLE AZ
85938-5104
US

IV. Provider business mailing address

118 S MOUNTAIN AVE
SPRINGERVILLE AZ
85938-5104
US

V. Phone/Fax

Practice location:
  • Phone: 928-333-4368
  • Fax: 928-333-4369
Mailing address:
  • Phone: 928-333-4368
  • Fax: 928-333-4369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2093
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: