Healthcare Provider Details

I. General information

NPI: 1134180078
Provider Name (Legal Business Name): DAVID HARRY MOORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 S EMERSON AVE SUITE 204
INDIANAPOLIS IN
46237-8601
US

IV. Provider business mailing address

PO BOX 664056
INDIANAPOLIS IN
46266-4056
US

V. Phone/Fax

Practice location:
  • Phone: 317-851-2555
  • Fax: 317-851-2566
Mailing address:
  • Phone: 317-780-3333
  • Fax: 317-780-3345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number01031933A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: