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1386866572

NPI Code Detail

MEDICARE: ANDREW MOORE

MEDICARE: ANDREW MOORE

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	207VE0102X	Reproductive Endocrinology Physician	8198024-1205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0722557	OTHER	KY	MEDICARE - FOUNDATION

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	3726872000	OTHER	KY	PASSPORT ADVANTAGE PCP
3	000000610833	OTHER	KY	ANTHEM
4	3726871000	OTHER	KY	PASSPORT ADVANTAGE SPECIALITY
5	9328408	OTHER	KY	AETNA
6	3726875000	OTHER	KY	PASSPORT ADVANTAGE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	50024901	OTHER	KY	PASSPORT SPECIALTY
9	50024902	OTHER	KY	PASSPORT PCP
10	000000610836	OTHER	KY	ANTHEM
11	50024905	OTHER	KY	PASSPORT SPECIALITY
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386866572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW MOORE

Provider Business Mailing Address
First Line	:	1900 N STATE ST STE 105
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-1354
Country	:	US
Telephone Number	:	801-655-5245
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 N STATE ST STE 105
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-1354
Country	:	US
Telephone Number	:	801-655-5245
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	02/23/2022

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Directions to “ ANDREW MOORE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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