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General NPI Number Information
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NPI Number | 1952528838
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Entity Type | Individual
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Provider Name | REBEKAH GRIFFIN MOORE PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1750 W 4TH ST SUITE 5
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City | MANSFIELD
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State | OH
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Zip | 44906-1770
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Country | US
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Telephone | 419-526-8444
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Fax | 419-529-8617
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Provider Business Mailing Address
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Address Line | 1957 CLIFFWOOD DR
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City | MANSFIELD
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State | OH
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Zip | 44904-1631
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Country | US
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Telephone | 419-571-2288
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Fax | 419-526-8617
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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 | 50-001308
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License Number State | OH
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