Individual
MR. WILLIAM M MOORE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2728 SUNSET BLVD STE 400, WEST COLUMBIA, SC 29169-4839
(803) 936-7095
(803) 936-7908
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
11908
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119080
—
SC
01
—
P00120188
RR MEDICARE
—
Enumeration date
08/10/2006
Last updated
11/10/2020
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