Provider Demographics
NPI:1619024759
Name:MOORE, JOAN L (DO)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:RT 1 ANTHONY CREEK ROAD
Mailing Address - Street 2:. BOX 97
Mailing Address - City:FRANKFORD
Mailing Address - State:WV
Mailing Address - Zip Code:24938-0097
Mailing Address - Country:US
Mailing Address - Phone:304-497-2752
Mailing Address - Fax:304-497-2752
Practice Address - Street 1:RT 1 BOX 123 ANTHONY CREEK ROAD
Practice Address - Street 2:.
Practice Address - City:FRANKFORD
Practice Address - State:WV
Practice Address - Zip Code:24938-0097
Practice Address - Country:US
Practice Address - Phone:304-497-2752
Practice Address - Fax:304-497-2752
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV944204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM