Basic Information
| Provider Information | |||||||||
| NPI: | 1730589458 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRS MOORE & STOCKSTILL PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5115 BERNARD DR | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240184357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403453556 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5104 BERNARD DR | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240184349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409047710 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2014 | ||||||||
| LastUpdateDate: | 08/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | STOCKSTILL | ||||||||
| AuthorizedOfficialFirstName: | KURT | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5403453556 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 101045664 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.