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General NPI Number Information
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NPI Number | 1962874628
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Entity Type | Organization
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Legal Business Name | THOMAS J MOORE MD LLC
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 190 KEENELAND TRL
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City | CORBIN
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State | KY
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Zip | 40701-8544
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Country | US
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Telephone | 606-215-1793
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Fax |
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Provider Business Mailing Address
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Address Line | 190 KEENELAND TRL
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City | CORBIN
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State | KY
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Zip | 40701-8544
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Country | US
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Telephone | 606-215-1793
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS J MOORE
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Credential | M.D.
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Telephone | 606-215-1793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 22596
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License Number State | KY
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