# M B MOORE MD ORTHOPAEDIC SURGEON PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639407323
- **Authorized official:** DR. MERWIN B MOORE III M.D. (OWNER)
- **Authorized official phone:** (870) 424-4710

## Contact information

- **Practice address:** 628 HOSPITAL DR, SUITE E, MOUNTAIN HOME, AR 72653-2953
- **Practice address phone:** (870) 424-4710
- **Practice address fax:** (870) 424-4780
- **Mailing address:** PO BOX 9178, RUSSELLVILLE, AR 72811-9178
- **Mailing address phone:** (479) 968-4273
- **Mailing address fax:** (479) 968-1363

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/18/2009
- **Last updated:** 06/25/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 180094002 | — | AR |
| 01 | — | 5G230 | BCBS | AR |