MEDICARE: MR. CHRIS ALAN MOORE RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	805015	NM

General Provider Information

NPI Number	:	1548211394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRIS ALAN MOORE RD

Provider Business Mailing Address
First Line	:	2611 LOS MISIONEROS
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-9018
Country	:	US
Telephone Number	:	505-521-5901
Fax Number	:	509-355-8154

Provider Business Practice Location Address
First Line	:	2611 LOS MISIONEROS
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-9018
Country	:	US
Telephone Number	:	505-521-5901
Fax Number	:	509-355-8154

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/08/2007

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