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General NPI Number Information
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NPI Number | 1043272339
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Entity Type | Individual
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Provider Name | REGINALD G MOORE MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 121 49TH AVENUE PL NW
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City | HICKORY
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State | NC
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Zip | 28601-9349
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Country | US
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Telephone | 828-381-3636
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Fax | 828-728-2030
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Provider Business Mailing Address
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Address Line | 121 49TH AVENUE PL NW
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City | HICKORY
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State | NC
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Zip | 28601-9349
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Country | US
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Telephone | 828-381-3636
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Fax | 828-728-2030
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23064
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 19853
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License Number State | GA
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