Provider Demographics
NPI:1861937740
Name:MOORE, GLORIA C (DEM)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:C
Last Name:MOORE
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4618 S RUSSELL ST APT B
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4549
Mailing Address - Country:US
Mailing Address - Phone:214-717-0689
Mailing Address - Fax:
Practice Address - Street 1:4618 S RUSSELL ST APT B
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4549
Practice Address - Country:US
Practice Address - Phone:214-717-0689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay