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1184646473

NPI Code Detail

MEDICARE: DR. KENNETH DAVID MOORE MD

MEDICARE: DR. KENNETH DAVID 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	207X00000X	Orthopaedic Surgery Physician	24165	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000025579	OTHER	AL	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	051503536	OTHER	AL	BLUE CROSS
5	051511207	OTHER	AL	BLUE CROSS
6	051529536	OTHER	AL	BLUE CROSS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	051503535	OTHER	AL	BLUE CROSS

General Provider Information

NPI Number	:	1184646473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH DAVID MOORE MD

Provider Business Mailing Address
First Line	:	805 SAINT VINCENTS DR STE 100
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-1638
Country	:	US
Telephone Number	:	205-939-3699
Fax Number	:	205-484-2585

Provider Business Practice Location Address
First Line	:	805 SAINT VINCENTS DR STE 100
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-1638
Country	:	US
Telephone Number	:	205-939-3699
Fax Number	:	205-484-2585

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	05/05/2025

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Directions to “ DR. KENNETH DAVID MOORE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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