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General NPI Number Information
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NPI Number | 1508507310
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Entity Type | Individual
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Provider Name | TYLER SCOTT MOORE DO
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Gender | Male
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 3681 N MAIN ST
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City | FARMVILLE
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State | NC
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Zip | 27828-1464
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Country | US
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Telephone | 252-753-7141
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Fax |
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Provider Business Mailing Address
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Address Line | 1850 W ARLINGTON BLVD
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City | GREENVILLE
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State | NC
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Zip | 27834-5704
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Country | US
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Telephone | 252-413-6641
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2024-02192
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License Number State | NC
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