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General NPI Number Information
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NPI Number | 1912177197
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Entity Type | Organization
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Legal Business Name | THE MOORE CLINIC, LLC
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 1709 S COLLEGE ST
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City | TRENTON
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State | TN
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Zip | 38382-3908
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Country | US
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Telephone | 731-855-2080
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Fax |
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Provider Business Mailing Address
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Address Line | 1709 S COLLEGE ST
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City | TRENTON
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State | TN
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Zip | 38382-3908
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Country | US
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Telephone | 731-855-2080
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Fax |
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Authorized Official
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Title or Position | CHIEF MANAGER
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Name | RAFAEL MARIO SANCHEZ
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Credential | D.O.
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Telephone | 731-414-1618
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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 |
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License Number State |
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