Provider Demographics
NPI:1235697236
Name:MOORE, RONALD CARL III
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:CARL
Last Name:MOORE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SHIVERS RUN CT
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-4732
Mailing Address - Country:US
Mailing Address - Phone:856-535-7797
Mailing Address - Fax:
Practice Address - Street 1:208 SHIVERS RUN CT
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-4732
Practice Address - Country:US
Practice Address - Phone:856-535-7797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer