Healthcare Provider Details

I. General information

NPI: 1457906737
Provider Name (Legal Business Name): PAUL BENJAMIN MOORE MSN, APRN, CPNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8050
  • Fax: 330-543-8054
Mailing address:
  • Phone: 330-543-8050
  • Fax: 330-543-8054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAPRN.CNP.025361
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.025361
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: