MEDICARE: THOMAS MOORE MD

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	207Q00000X	Family Medicine Physician	26375	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	:	1578507026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS MOORE MD

Provider Business Mailing Address
First Line	:	PO BOX 950248
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0248
Country	:	US
Telephone Number	:	502-489-5730
Fax Number	:	502-489-5753

Provider Business Practice Location Address
First Line	:	2400 EASTPOINT PKWY
Second Line	:	SUITE 550
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4154
Country	:	US
Telephone Number	:	502-253-6630
Fax Number	:	502-253-6639

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	01/26/2015

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Directions to “ THOMAS MOORE MD” Practice Location

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