Individual
I. ELAINE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
311 8TH AVE, SAINT ALBANS, WV 25177
(304) 807-5131
Mailing address
311 8TH AVE, SAINT ALBANS, WV 25177-2855
(304) 807-5131
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15837
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0043622000
—
WV
Enumeration date
07/24/2006
Last updated
06/08/2018
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