Provider Demographics
NPI:1982154985
Name:MOORE, ANTHONY JR
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MOORE
Suffix:JR
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 1:640 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2498
Mailing Address - Country:US
Mailing Address - Phone:313-346-2756
Mailing Address - Fax:
Practice Address - Street 1:640 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2498
Practice Address - Country:US
Practice Address - Phone:313-346-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider