Individual
DR. PAUL BEVERIDGE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
273 WINTON M BLOUNT LOOP, MONTGOMERY, AL 36117-3507
(334) 280-1500
(334) 280-1600
Mailing address
PO BOX 241587, MONTGOMERY, AL 36124-1587
(334) 280-1500
(334) 280-1600
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
11047
AL
207RI0011X
Interventional Cardiology Physician
Primary
11047
AL
207UN0901X
Nuclear Cardiology Physician
11047
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051007015
BLUE SHIELD PROVIDER #
AL
01
—
051017844
BLUE SHIELD PROVIDER #
AL
01
—
11047
MEDICAL LICENSE
AL
05
—
17844
—
AL
Enumeration date
07/10/2006
Last updated
03/07/2023
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