Individual
CODY WAYNE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
401 E CHESTNUT ST UNIT 310, LOUISVILLE, KY 40202-5703
(502) 588-4720
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-4720
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
55332
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100609390
—
KY
Enumeration date
03/26/2018
Last updated
06/15/2021
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