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General NPI Number Information
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NPI Number | 1336302280
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Entity Type | Individual
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Provider Name | MICHAEL R MOORE M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 1003 SOUTH MAIN STREET
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City | EMININCE
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State | MO
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Zip | 65466-0100
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Country | US
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Telephone | 573-226-5505
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Fax | 573-226-5584
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Provider Business Mailing Address
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Address Line | PO BOX 157
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City | ELLINGTON
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State | MO
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Zip | 63638-0157
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Country | US
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Telephone | 573-663-2313
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Fax | 573-663-2322
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | R4837
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License Number State | MO
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