Basic Information
| Provider Information | |||||||||
| NPI: | 1659717163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | PAUL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 854 PARKCREST DR | ||||||||
| Address2: | |||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286075198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287732702 | ||||||||
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| Practice Location | |||||||||
| Address1: | 108 DOCTORS DR | ||||||||
| Address2: | |||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286075000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282623886 | ||||||||
| FaxNumber: | 8282654816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2013 | ||||||||
| LastUpdateDate: | 09/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | L002554 | NC | N | Dietary & Nutritional Service Providers | Nutritionist | 133NN1002X | L002554 | NC | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 133V00000X | 949600 | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.