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NPI Code Detail

MEDICARE: KEVIN MOORE MD

MEDICARE: KEVIN 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
1207L00000XAnesthesiology Physician35064203OH

General Provider Information

NPI Number : 1407853047
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN MOORE MD
Provider Business Mailing Address
First Line : 11490 SPRINGFIELD PIKE
Second Line :
City : CINCINNATI
State : OH
Zip : 45246-3524
Country : US
Telephone Number : 513-672-3309
Fax Number : 513-672-3323
Provider Business Practice Location Address
First Line : 401 MATTHEW ST
Second Line :
City : MARIETTA
State : OH
Zip : 45750-1635
Country : US
Telephone Number : 740-568-5427
Fax Number : 740-376-5073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 02/02/2022

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Directions to “ KEVIN MOORE MD” Practice Location

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