Moore, Mark S

Moore, Mark S is an individual health care provider with primary practice located at 1008 Minnequa Ave , Pueblo CO 81004-3733. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Moore, Mark S can be contacted via phone (719) 557-4000.

Contact Information

Primary practice address
1008 Minnequa Ave Pueblo CO 81004-3733
Phone: (719) 557-4000
Fax: (970) 342-2093
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 112240 Missouri

Profile Details

NPI number 1457465429
LBN Legal business name Moore, Mark S
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 18th, 2006
Last updated Nov 5th, 2020 - about 4 years ago

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 1457465429 NPPES
Other 100180650B OK CAID
Other 100343220A OK CAID
MEDICAID 83787844 OK CAID
Other 451258 OK CAID
Other 115634 OK CAID
Other 112240 OK CAID
MEDICAID 248699902 OK CAID

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