MEDICARE: FREDERICK STEPHEN MOORE MD

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	207RG0100X	Gastroenterology Physician	022254	GA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	022254	GA
3	207RG0100X	Gastroenterology Physician	164074	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104876440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK STEPHEN MOORE MD

Provider Business Mailing Address
First Line	:	PO BOX 907790
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-0912
Country	:	US
Telephone Number	:	770-536-8109
Fax Number	:	770-536-3203

Provider Business Practice Location Address
First Line	:	2324 LIMESTONE OVERLOOK
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-7443
Country	:	US
Telephone Number	:	770-536-8109
Fax Number	:	770-536-3203

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	10/15/2025

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