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General NPI Number Information
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NPI Number | 1396872636
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Entity Type | Organization
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Legal Business Name | MOORE SURGICAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 901 LINCOLNWAY SUITE 304
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City | LA PORTE
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State | IN
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Zip | 46350-3430
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Country | US
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Telephone | 219-362-8523
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Fax | 219-324-9396
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Provider Business Mailing Address
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Address Line | 901 LINCOLNWAY SUITE 304
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City | LA PORTE
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State | IN
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Zip | 46350-3430
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Country | US
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Telephone | 219-362-8523
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Fax | 219-324-9396
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. WAYNE E MOORE
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Credential | M.D.
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Telephone | 219-362-8523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 50000416
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License Number State | IN
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