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NPI Code Detail

MEDICARE: ALFRED DENTON MOORE M.D.

MEDICARE: ALFRED DENTON MOORE M.D.
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
1207P00000XEmergency Medicine Physician010654SC
2207R00000XInternal Medicine Physician010654SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00211213OTHERSCRAILROAD-MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609819416
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALFRED DENTON MOORE M.D.
Provider Business Mailing Address
First Line : PO BOX 287
Second Line :
City : GREENVILLE
State : SC
Zip : 29602-0287
Country : US
Telephone Number : 864-729-8330
Fax Number : 864-751-0479
Provider Business Practice Location Address
First Line : 975 W FARIS RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29605-4241
Country : US
Telephone Number : 864-729-8330
Fax Number : 864-751-0479
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 10/26/2016

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Directions to “ ALFRED DENTON MOORE M.D.” Practice Location

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