Moore, Colleen Johnson

Moore, Colleen Johnson is an individual health care provider with primary practice located at 21 Doctors Park Ste A , Cape Girardeau MO 63703-4927. She recently has only one registered license in Allopathic & Osteopathic Physicians / Vascular Surgery, which is considered as her primary health care specialty. Moore, Colleen Johnson can be contacted via phone (217) 788-0706.

Contact Information

Primary practice address
21 Doctors Park Ste A Cape Girardeau MO 63703-4927
Phone: (217) 788-0706
Fax: (217) 525-2535
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 2004001641 Missouri
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 036113689 Illinois

Profile Details

NPI number 1801877923
LBN Legal business name Moore, Colleen Johnson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 7th, 2005
Last updated Jul 27th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801877923 NPPES
Illinois MEDICAID 036113689
Illinois Other F400526418

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