NPI 1073815882

Stephen G Moore, MD

Practitioner Specialist Bloomington, IN

Practice location

Address: 2749 E Covenanter Dr, Bloomington, IN 47401-5454
Phone: (812) 332-2265
Fax: (812) 334-0853

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence 01044533A (IN)

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Registry record

NPI: 1073815882
Entity type: Individual
Sex (as registered): Male
NPI issued: 30 Nov 2010
Record last updated: 30 Nov 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.