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General NPI Number Information
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NPI Number | 1689848525
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Entity Type | Organization
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Legal Business Name | CORBIN LONDON MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 07/28/2011
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Provider Practice Location Address
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Address Line | 1007 CUMBERLAND FALLS HWY
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City | CORBIN
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State | KY
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Zip | 40701
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Country | US
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Telephone | 606-528-0305
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Fax | 606-523-4368
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Provider Business Mailing Address
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Address Line | 1007 CUMBERLAND FALLS HWY
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City | CORBIN
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State | KY
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Zip | 40701
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Country | US
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Telephone | 606-528-0305
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Fax | 606-523-4368
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. JONATHAN E. MOORE
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Credential | M.D.
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Telephone | 606-528-0305
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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 | 1086037
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 39404
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 002008
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1033143
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License Number State | KY
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