MEDICARE: LEANN RUTH DEAL 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	39041	NC

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
2	60376	OTHER	NC	BCBS OF NC

General Provider Information

NPI Number	:	1659327864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANN RUTH DEAL MOORE MD

Provider Business Mailing Address
First Line	:	PO BOX 12248
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28561-2248
Country	:	US
Telephone Number	:	252-636-2664
Fax Number	:	252-636-8305

Provider Business Practice Location Address
First Line	:	3252 WELLONS BLVD
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-5234
Country	:	US
Telephone Number	:	252-636-2664
Fax Number	:	252-636-8305

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	03/21/2014

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