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General NPI Number Information
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NPI Number | 1902432644
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Entity Type | Individual
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Provider Name | MADISON ALEXIS MOORE PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/13/2020
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 36701 AMERICAN WAY STE 3
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City | AVON
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State | OH
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Zip | 44011-4064
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Country | US
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Telephone | 440-937-4951
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Fax |
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Provider Business Mailing Address
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Address Line | 24603 E OAKLAND RD
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City | BAY VILLAGE
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State | OH
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Zip | 44140-2753
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Country | US
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Telephone | 440-915-4084
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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 | 50.007933RX
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License Number State | OH
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