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General NPI Number Information
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NPI Number | 1518349984
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Entity Type | Individual
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Provider Name | CHRISTOPHER MOORE DO
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Gender | Male
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Dates
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Enumeration Date | 06/22/2015
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 206 S WASHINGTON ST STE A
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City | MC LEANSBORO
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State | IL
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Zip | 62859-5607
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Country | US
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Telephone | 618-643-2835
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Fax |
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Provider Business Mailing Address
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Address Line | 24345 HIGHWAY 15
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City | UNION
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State | MS
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Zip | 39365-8575
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036162078
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25257
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License Number State | MS
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