Individual
BRETT W MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10500 MONTGOMERY ROAD, CINCINNATI, OH 45242-4402
(513) 865-2246
(513) 865-5596
Mailing address
PO BOX 636799, CINCINNATI, OH 45263-0001
(513) 569-5027
(513) 569-5199
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35062552
OH
207R00000X
Internal Medicine Physician
35.062552
OH
208M00000X
Hospitalist Physician
Primary
35.062552
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000358968
BCBS
OH
05
—
2034926
—
OH
01
—
P00224123
RAIL ROAD MEDICARE
—
Enumeration date
05/16/2006
Last updated
05/25/2017
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