Individual
DR. OLYN FRED MOORE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
503 TICKLE STREET, DYERSBURG, TN 38024
(731) 285-5244
(731) 285-8970
Mailing address
503 TICKLE STREET, SUITE #1, DYERSBURG, TN 38024
(731) 285-5244
(731) 285-8970
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD012164
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117022
TENNCARE UNISOM
TN
01
—
2003420
BLUE CROSS BLUE SHIELD
TN
05
—
3008574
—
TN
Enumeration date
04/06/2006
Last updated
07/31/2018
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