Moore, Randall D.

Moore, Randall D. is an individual health care provider with primary practice located at 800 East Carpenter Street Room 2K64, Springfield IL 62769-0001. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Moore, Randall D. can be contacted via phone (217) 525-5643.

Contact Information

Primary practice address
800 East Carpenter Street Room 2K64 Springfield IL 62769-0001
Phone: (217) 525-5643
Fax: (217) 544-2521
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 041318849 Illinois

Profile Details

NPI number 1679562532
LBN Legal business name Moore, Randall D.
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 13th, 2005
Last updated Jul 8th, 2007 - about 19 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 1679562532 NPPES
Illinois Other 041318849 IL LICENSE #
Illinois Other 72807 IL LICENSE #
Illinois Other 209-005619 IL LICENSE #
Illinois Other 371115308 IL LICENSE #
Illinois Other 0841504038 IL LICENSE #

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