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General NPI Number Information
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NPI Number | 1821312174
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Entity Type | Individual
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Provider Name | DANIEL J MOORE PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 6465 MILLENNIUM SUITE 100
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City | LANSING
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State | MI
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Zip | 48917-6880
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Country | US
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Telephone | 517-975-3720
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Fax | 517-975-3748
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Provider Business Mailing Address
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Address Line | 401 S BALLENGER HWY
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City | FLINT
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State | MI
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Zip | 48532-3638
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Country | US
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Telephone | 810-342-1000
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Fax | 810-342-1590
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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 | 5601004846
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License Number State | MI
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