Moore, Marla J

Moore, Marla J is an individual health care provider with primary practice located at 1200 Sixth Ave N Centracare Clinic, St Cloud MN 56303-2735. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine, which is considered as her primary health care specialty. Moore, Marla J can be contacted via phone (320) 252-5731.

Contact Information

Primary practice address
1200 Sixth Ave N Centracare Clinic St Cloud MN 56303-2735
Phone: (320) 252-5731
Fax: (719) 447-8987
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine 2080P0203X 36444 Colorado
Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine 2080P0203X CO36444 Colorado
Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine 2080P0203X MD11545 Hawaii
Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine 2080P0203X 105796 Minnesota

Profile Details

NPI number 1376507608
LBN Legal business name Moore, Marla J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 13th, 2006
Last updated Oct 27th, 2011 - about 13 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 1376507608 NPPES
Colorado MEDICAID 32804377

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