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NPI Code Detail

MEDICARE: DR. MALCOLM S MOORE JR. M.D.

MEDICARE: DR. MALCOLM S MOORE JR. 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
1207W00000XOphthalmology Physician031996GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1180024624OTHERGARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629041322
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MALCOLM S MOORE JR. M.D.
Provider Business Mailing Address
First Line : PO BOX 11407
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35246-8575
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1429 OGLETHORPE ST
Second Line :
City : MACON
State : GA
Zip : 31201-1512
Country : US
Telephone Number : 478-743-7061
Fax Number : 478-743-6296
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2006
Last Update Date : 07/22/2025

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