MEDICARE: MATTHEW D 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	35055799M	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2060101	OTHER	UHC
2	000000281392	OTHER	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760593230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW D MOORE MD

Provider Business Mailing Address
First Line	:	1911 N FAIRFIELD RD
Second Line	:	STE 110
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2762
Country	:	US
Telephone Number	:	937-429-4369
Fax Number	:	937-429-4575

Provider Business Practice Location Address
First Line	:	1911 N FAIRFIELD RD
Second Line	:	STE 110
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2762
Country	:	US
Telephone Number	:	937-429-4369
Fax Number	:	937-429-4575

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	02/13/2013

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Directions to “ MATTHEW D MOORE MD” Practice Location

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