NPI 1275104655

Richard L Moore

Practitioner Supports Brokerage Agency Medina, OH

Practice location

Address: 5000 Gateway Dr Suite 213, Medina, OH 44256
Phone: (330) 461-1164

Registered specialties

Supports Brokerage Agency Primary

Agencies Taxonomy 251X00000X

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Registry record

NPI: 1275104655
Entity type: Individual
Sex (as registered): Male
NPI issued: 7 Jul 2021
Record last updated: 21 Jul 2021

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.