Individual
DR. RYAN THOMAS MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2100 STANTONSBURG RD, GREENVILLE, NC 27834-2818
(252) 847-4378
(252) 847-9943
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0101237078
VA
2080N0001X
Neonatal-Perinatal Medicine Physician
0101237078
VA
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
2014-01603
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063493880
—
NC
01
—
19CN7
BCBS NC
NC
Enumeration date
11/09/2005
Last updated
02/22/2024
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