Individual
GARY RANDALL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
515 READ ST, EVANSVILLE, IN 47710-1739
(812) 424-9291
(812) 421-2722
Mailing address
515 READ ST, EVANSVILLE, IN 47710-1739
(812) 424-9291
(812) 421-2722
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01030659A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000067659
ANTHEM BCBS
IN
01
—
0231480001
MEDICARE DME
IN
05
—
100179870
—
IN
Enumeration date
05/27/2005
Last updated
11/26/2019
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