# MRS. MODJULIE ALEXANDRA MOORE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1730475336
- **Gender:** F
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 2014-01158 | NC | Yes |
| 207Q00000X | Family Medicine Physician | 248569 | MA | — |

## Other

- **Enumeration date:** 06/22/2011
- **Last updated:** 03/31/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1730475336 | TRICARE | NC |
| 05 | — | 1730475336 | — | NC |
| 01 | — | 1885D | BCBS | NC |
| 01 | — | 4012742 | CIGNA | NC |
| 01 | — | 5138994 | UNITEDHEALTHCARE | NC |
| 01 | — | 5803998 | AETNA | NC |