MEDICARE: DR. JAMES N MOORE III 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	23140	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080183608	OTHER	SC	RAIL ROAD MEDICARE

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	:	1467441329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES N MOORE III MD

Provider Business Mailing Address
First Line	:	3655 MITCHELL ST
Second Line	:
City	:	LORIS
State	:	SC
Zip	:	29569-2827
Country	:	US
Telephone Number	:	843-716-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3655 MITCHELL ST
Second Line	:
City	:	LORIS
State	:	SC
Zip	:	29569-2827
Country	:	US
Telephone Number	:	843-716-7000
Fax Number	:

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	02/03/2012

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