Individual
JACK C MOORE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
175 S ENGLISH STATION RD STE 226, LOUISVILLE, KY 40245
(502) 244-0911
(502) 253-0581
Mailing address
100 E LIBERTY ST STE 800, LOUISVILLE, KY 40202-1428
(502) 244-0911
(502) 253-0581
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01069727A
IN
207Q00000X
Family Medicine Physician
Primary
34365
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64040173
—
KY
01
—
P01073440
MEDICARE RAILROAD
KY
Enumeration date
07/21/2006
Last updated
08/19/2019
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