Healthcare Provider Details

I. General information

NPI: 1821081472
Provider Name (Legal Business Name): WAYNE E MOORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 ALBION ST METROPOLITAN NASHVILLE GENERAL HOSPITAL EMERGENCY DEPT
NASHVILLE TN
37208-2918
US

IV. Provider business mailing address

916 QUAIL VALLEY DR
BRENTWOOD TN
37027-5806
US

V. Phone/Fax

Practice location:
  • Phone: 615-341-4000
  • Fax: 615-837-4514
Mailing address:
  • Phone: 615-566-6188
  • Fax: 615-837-4514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number26654
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number26654
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: