MEDICARE: CAROLYN 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	30072	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080096401	OTHER	KY	RAILROAD MEDICARE
2	080099911	OTHER	KY	RAILROAD MEDICARE
3	080104514	OTHER	KY	RAILROAD MEDICARE
5	080077589	OTHER	KY	RAILROAD MEDICARE
6	080069346	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578544672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN MOORE MD

Provider Business Mailing Address
First Line	:	PO BOX 1268
Second Line	:
City	:	OLIVE HILL
State	:	KY
Zip	:	41164-1268
Country	:	US
Telephone Number	:	606-286-4152
Fax Number	:	606-286-2385

Provider Business Practice Location Address
First Line	:	155 BRICKLAYER STREET
Second Line	:
City	:	OLIVE HILL
State	:	KY
Zip	:	41164
Country	:	US
Telephone Number	:	606-286-4152
Fax Number	:	606-286-2385

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	09/22/2015

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Directions to “ CAROLYN MOORE MD” Practice Location

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