Healthcare Provider Details

I. General information

NPI: 1619330719
Provider Name (Legal Business Name): ZACHARY DAVIS MOORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7938 AL HIGHWAY 69 STE 100
GUNTERSVILLE AL
35976-7135
US

IV. Provider business mailing address

927 FRANKLIN ST SE
HUNTSVILLE AL
35801-4306
US

V. Phone/Fax

Practice location:
  • Phone: 256-539-2728
  • Fax:
Mailing address:
  • Phone: 256-539-2728
  • Fax: 256-539-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD.36773
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD.36773
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: