Healthcare Provider Details

I. General information

NPI: 1932216991
Provider Name (Legal Business Name): KAY L MOORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WOODCROSS DR
COLUMBIA SC
29212-2331
US

IV. Provider business mailing address

74 POLO RD
COLUMBIA SC
29223-2806
US

V. Phone/Fax

Practice location:
  • Phone: 803-732-0140
  • Fax: 803-732-4848
Mailing address:
  • Phone: 803-788-6146
  • Fax: 803-462-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13663
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: