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General NPI Number Information
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NPI Number | 1083643589
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Entity Type | Individual
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Provider Name | STEPHEN T MOORE D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 1101 NEAL ST SUITE 102
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City | COOKEVILLE
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State | TN
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Zip | 38501-0917
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Country | US
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Telephone | 931-526-1581
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Fax | 931-526-5973
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Provider Business Mailing Address
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Address Line | 1101 NEAL ST SUITE 102
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City | COOKEVILLE
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State | TN
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Zip | 38501-0901
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Country | US
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Telephone | 931-526-1581
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | DO0000001305
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License Number State | TN
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