MEDICARE: PAUL E 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	207Q00000X	Family Medicine Physician	22393	KY

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
2	000000062228	OTHER		ANTHEM

General Provider Information

NPI Number	:	1326002023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL E MOORE MD

Provider Business Mailing Address
First Line	:	471 KLUTEY PARK PLAZA DR
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-3347
Country	:	US
Telephone Number	:	270-830-6100
Fax Number	:	270-826-3089

Provider Business Practice Location Address
First Line	:	110 3RD ST STE 250
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-5802
Country	:	US
Telephone Number	:	270-826-0135
Fax Number	:	270-827-8798

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	03/11/2019

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Directions to “ PAUL E MOORE MD” Practice Location

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