MEDICARE: DEBORAH S MOORE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY703	AL

General Provider Information

NPI Number	:	1063678993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH S MOORE PH.D.

Provider Business Mailing Address
First Line	:	2592 INDIAN HILL RD
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-6429
Country	:	US
Telephone Number	:	334-744-7835
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 MIMOSA AVE
Second Line	:
City	:	UNION SPRINGS
State	:	AL
Zip	:	36089-2127
Country	:	US
Telephone Number	:	334-318-5108
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2008
Last Update Date	:	07/30/2008

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