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NPI Code Detail

MEDICARE: KEITH S MOORE M.D.

MEDICARE: KEITH S MOORE M.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
1208600000XSurgery PhysicianM8850TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00614620OTHERTXRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28G6219OTHERTXBC/BS TX#

General Provider Information

NPI Number : 1154302784
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH S MOORE M.D.
Provider Business Mailing Address
First Line : 1100 JOHNSON FY RD NE
Second Line : SUITE 165
City : ATLANTA
State : GA
Zip : 30342-1709
Country : US
Telephone Number : 404-446-2800
Fax Number : 404-446-2809
Provider Business Practice Location Address
First Line : 1100 JOHNSON FY RD NE
Second Line : SUITE 165
City : ATLANTA
State : GA
Zip : 30342-1709
Country : US
Telephone Number : 404-446-2800
Fax Number : 404-446-2809
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 11/30/2016

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Directions to “ KEITH S MOORE M.D.” Practice Location

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