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General NPI Number Information
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NPI Number | 1467560631
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Entity Type | Individual
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Provider Name | RICHARD BRUCE MOORE PA
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Gender | Male
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 02/10/2009
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Provider Practice Location Address
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Address Line | 1907 W MORRIS BLVD SUITE B
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City | MORRISTOWN
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State | TN
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Zip | 37813-3860
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Country | US
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Telephone | 423-587-2707
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Fax | 423-587-3224
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Provider Business Mailing Address
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Address Line | PO BOX 70
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City | BULLS GAP
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State | TN
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Zip | 37711-0070
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Country | US
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Telephone | 423-235-0063
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA0000001279
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License Number State | TN
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