Brady Joseph Moore
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Staunton, IL
NPI 1376907931 · NPPES record last updated Apr 11, 2016
Key facts
- NPI
- 1376907931
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 304 W 8TH St
Staunton, IL 62088-2018 - Phone
- (217) 929-8006
- NPI assigned
- Apr 11, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
304 W 8TH St
Staunton, IL 62088-2018
Mailing address
304 W 8TH St
Staunton, IL 62088-2018
Phone (217) 929-8006
Other providers in Staunton, IL
- Macoupin County Chiro Partnership
- Manish Mathur
- Walter Alan McDonald
- Midwest Emergency Anderson Health, Inc
- Tamar Montoya-Albrecht
- Janene Marie Parmentier
- Tyler Peteron
- Nicolas C Pineda
- Mia Lynn Rhodes
- Karen K. Robertson
All providers in Staunton, IL · Student in an Organized Health Care Education/Training Program in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.