MEDICARE: STEPHANY K 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	207RC0000X	Cardiovascular Disease Physician	35080685	OH

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	:	1376529347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANY K MOORE MD

Provider Business Mailing Address
First Line	:	5400 FRANTZ RD
Second Line	:	STE 250
City	:	DUBLIN
State	:	OH
Zip	:	43016-6102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 CLARK ST
Second Line	:
City	:	CAMBRIDGE
State	:	OH
Zip	:	43725-9614
Country	:	US
Telephone Number	:	740-630-9708
Fax Number	:	740-630-9709

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	08/23/2017

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Directions to “ STEPHANY K MOORE MD” Practice Location

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