Provider Demographics
NPI:1649487356
Name:MOORE, JOHN W (RCP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:MOORE
Suffix:
Gender:M
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:271 NORTH L STREET
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-2107
Mailing Address - Country:US
Mailing Address - Phone:559-591-1820
Mailing Address - Fax:559-591-8225
Practice Address - Street 1:271 NORTH L STREET
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-2107
Practice Address - Country:US
Practice Address - Phone:559-591-1820
Practice Address - Fax:559-591-8225
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARCP65562278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care