Individual
PAUL DOUGLAS MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
910 N MAIN ST STE 100, FOUNTAIN INN, SC 29644-1320
(864) 967-4982
Mailing address
1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536
(864) 797-6174
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23342
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4591406
AETNA ID
SC
Enumeration date
06/15/2006
Last updated
09/18/2024
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