Healthcare Provider Details

I. General information

NPI: 1801214093
Provider Name (Legal Business Name): MOORE FAMILY MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 SAUNDERS ST
CARTHAGE NC
28327-9343
US

IV. Provider business mailing address

304 SAUNDERS ST
CARTHAGE NC
28327-9343
US

V. Phone/Fax

Practice location:
  • Phone: 910-947-3000
  • Fax:
Mailing address:
  • Phone: 910-947-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9601161
License Number StateNC

VIII. Authorized Official

Name: THOMAS R LEONARD
Title or Position: PRESIDENT
Credential: M.D
Phone: 910-947-3000