Individual
KENNETH MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2460 CURTIS ELLIS DR, ROCKY MOUNT, NC 27804-2237
(252) 443-8172
Mailing address
PO BOX 409540, ATLANTA, GA 30384-9540
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
9800098
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89135T6
—
NC
Enumeration date
09/06/2006
Last updated
07/09/2007
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