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General NPI Number Information
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NPI Number | 1164934824
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Entity Type | Organization
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Legal Business Name | MARTIN L. MOORE APC
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Dates
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Enumeration Date | 11/02/2017
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Last Update Date | 11/27/2019
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Provider Practice Location Address
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Address Line | 5050 CHAPPELET DR
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City | SPARKS
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State | NV
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Zip | 89436-8132
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Country | US
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Telephone | 775-857-7508
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Fax |
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Provider Business Mailing Address
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Address Line | 5050 CHAPPELET DR
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City | SPARKS
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State | NV
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Zip | 89436-8132
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Country | US
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Telephone | 775-857-7508
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Fax | 775-356-8101
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARTIN LOUIS MOORE
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Credential |
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Telephone | 775-857-7508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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