Provider Demographics
NPI:1235218850
Name:MOORE, FRANCIS BERNARD (PA)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:BERNARD
Last Name:MOORE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGERVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:85938-5104
Mailing Address - Country:US
Mailing Address - Phone:928-333-4368
Mailing Address - Fax:928-333-4369
Practice Address - Street 1:118 S MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGERVILLE
Practice Address - State:AZ
Practice Address - Zip Code:85938-5104
Practice Address - Country:US
Practice Address - Phone:928-333-4368
Practice Address - Fax:928-333-4369
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2093363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ442517Medicaid
AZ442517Medicaid
AZS63197Medicare UPIN