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General NPI Number Information
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NPI Number | 1518190370
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Entity Type | Individual
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Provider Name | DAVID MICHAEL MOORE PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 1662 HIGDON FERRY ROAD STE 300
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City | HOT SPRINGS
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State | AR
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Zip | 71913
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Country | US
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Telephone | 501-321-2663
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21190 STE 300
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City | HOT SPRINGS
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State | AR
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Zip | 71903-1190
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Country | US
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Telephone | 501-321-2663
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | P-T0916
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License Number State | AR
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