Healthcare Provider Details

I. General information

NPI: 1437671377
Provider Name (Legal Business Name): GENE MOORE MD P LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 SO WILLIAMS ST
BURLINGTON VT
05401
US

IV. Provider business mailing address

28 S WILLIAMS ST
BURLINGTON VT
05401-3486
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-7080
  • Fax: 802-863-0411
Mailing address:
  • Phone: 802-864-7080
  • Fax: 802-863-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042010189
License Number StateVT

VIII. Authorized Official

Name: MRS. DEB A CAISE
Title or Position: OFFICE MANAGER
Credential:
Phone: 802-864-7080