Moore, Sam

Moore, Sam is an individual health care provider with primary practice located at 1701 W. Curtis , Champaign IL 61822-9678. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Moore, Sam can be contacted via phone (217) 365-6203.

Contact Information

Primary practice address
1701 W. Curtis Champaign IL 61822-9678
Phone: (217) 365-6203
Fax: (217) 383-4752
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036075380 Illinois

Profile Details

NPI number 1972516797
LBN Legal business name Moore, Sam
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 14th, 2006
Last updated Dec 11th, 2013 - about 11 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 1972516797 NPPES
Illinois Other IL2613 MEDICARE GROUP PTAN

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