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NPI Code Detail

MEDICARE: SCOT B MOORE MD

MEDICARE: SCOT B 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
1208000000XPediatrics Physician01044878IN
2208000000XPediatrics Physician01044878AIN

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 : 1821096462
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOT B MOORE MD
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 350 S LANDMARK AVE
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-5001
Country : US
Telephone Number : 812-334-9995
Fax Number : 812-335-7604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 09/02/2022

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Directions to “ SCOT B MOORE MD” Practice Location

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