1265873277 NPI number — GEORGE MOORE, MD PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265873277 NPI number — GEORGE MOORE, MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE MOORE, MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265873277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11081 FOREST PINES DR
Provider Second Line Business Mailing Address:
SUITE 124
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27614-7655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-435-6967
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11081 FOREST PINES DR
Provider Second Line Business Practice Location Address:
SUITE 124
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27614-7655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-435-6967
Provider Business Practice Location Address Fax Number:
888-941-6387
Provider Enumeration Date:
07/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
HORACE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
919-607-0623

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  26325 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8960521 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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