Individual
CHARLES A MOORE
Active
Individual
CHARLES A MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22757
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000062741
BLUE CROSS OF KY
KY
01
—
000000251586
BLUE CROSS OF VA
VA
01
—
000051203
BLUE CROSS OF TENNESSEE
TN
01
—
006064205
VA MEDICAID
VA
01
—
017423400
BLACK LUNG
KY
05
—
1003816372
—
KY
01
—
110196198
RAIL ROAD MEDICARE
KY
01
—
1143
CHA
KY
01
—
1326780
UMWA
KY
01
—
1635649000
DEPARTMENT OF LABOR
KY
01
—
1659551935
MEDICARE GROUP NPI
KY
01
—
4176527
TENNESSE MEDICAID
TN
05
—
64227572
—
KY
Enumeration date
07/28/2005
Last updated
04/27/2010
Update your record
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