Individual provider · Type 1 NPI
Patricia Louise Moore, MEDICAID PROVIDER
Medical Physician Assistant · Indianaplis, IN
NPI number
1356643324
Active
Practice location
1453 S. Bancroft
Indianaplis, IN 46203-3709
Mailing address
3601 Decamp Dr
Indianapolis, IN 46226-6040
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | 200974970A (IN) |
Medical Physician Assistant: Definition to come...
About NPI 1356643324
Patricia Louise Moore, MEDICAID PROVIDER's National Provider Identifier is 1356643324, issued on Nov 24, 2010. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Indianaplis, IN. The record was last updated on May 4, 2011.