Individual
DR. STEPHEN T MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1101 NEAL ST, SUITE 102, COOKEVILLE, TN 38501-0917
(931) 526-1581
(931) 526-5973
Mailing address
1101 NEAL ST, SUITE 102, COOKEVILLE, TN 38501-0901
(931) 526-1581
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
DO0000001305
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3158681
BCBS PROVIDER NUMBER
TN
05
—
3305996
—
TN
01
—
621833951
TAX ID/PROVIDER NUMBER
TN
Enumeration date
06/30/2006
Last updated
07/14/2014
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