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General NPI Number Information
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NPI Number | 1609828466
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Entity Type | Individual
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Provider Name | JOHN L MOORE MD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 1800 ROBERTS ST
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City | CAMDEN
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State | SC
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Zip | 29020-3759
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Country | US
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Telephone | 803-432-6186
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Fax | 803-432-1177
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Provider Business Mailing Address
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Address Line | PO BOX 1259 SENTINEL HEALTH PARTNERS PA BUSINESS OFFICE
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City | CAMDEN
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State | SC
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Zip | 29021
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Country | US
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Telephone | 803-713-8350
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Fax | 803-713-8433
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 7066
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License Number State | SC
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