Individual
JEFFREY KEITH MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
421 CHESTNUT ST, EVANSVILLE, IN 47713-1227
(812) 426-9355
(812) 858-4539
Mailing address
PO BOX 3868, EVANSVILLE, IN 47737-3868
(812) 426-9355
(812) 858-4539
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01029516
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000109394
ANTHEM
IN
01
—
070005453
RAILROAD
—
05
—
100078540
—
IN
01
—
64755457
KY MEDICAID
KY
Enumeration date
11/30/2006
Last updated
01/08/2013
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