=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265873277
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEORGE MOORE, MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2013
-----------------------------------------------------
Last Update Date | 07/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11081 FOREST PINES DR SUITE 124
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27614-7655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-435-6967
-----------------------------------------------------
Fax | 888-941-6387
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11081 FOREST PINES DR SUITE 124
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27614-7655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-435-6967
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GEORGE HORACE MOORE JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 919-607-0623
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 26325
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------