MEDICARE: DR. ANNA ELIZABETH 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	35.149135	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35.149135	OTHER	OH	MEDICAL LICENSE

General Provider Information

NPI Number	:	1518595701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA ELIZABETH MOORE MD

Provider Business Mailing Address
First Line	:	1715 BROWN ST STE 200
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-2502
Country	:	US
Telephone Number	:	937-208-9010
Fax Number	:	937-208-9020

Provider Business Practice Location Address
First Line	:	1715 BROWN ST STE 200
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-2502
Country	:	US
Telephone Number	:	937-208-9010
Fax Number	:	937-208-9020

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

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	03/27/2025

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