MEDICARE: PAUL M MOORE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	32916	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295734515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL M MOORE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2697
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42102-7697
Country	:	US
Telephone Number	:	270-745-1467
Fax Number	:	270-745-1417

Provider Business Practice Location Address
First Line	:	350 PARK ST
Second Line	:	SUITE 210
City	:	BOWLING GREEN
State	:	KY
Zip	:	42101-1784
Country	:	US
Telephone Number	:	270-796-3330
Fax Number	:	270-796-3338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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Directions to “ PAUL M MOORE M.D.” Practice Location

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