Individual
DR. BRANDON K MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
301 MED TECH PKWY STE 240, JOHNSON CITY, TN 37604-2641
(423) 794-5520
(423) 282-6940
Mailing address
215 E SPRINGBROOK DR, JOHNSON CITY, TN 37601-1761
(423) 794-5520
(423) 282-6940
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0102202866
VA
207R00000X
Internal Medicine Physician
Primary
2317
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396908430
—
NC
05
—
1396908430
—
VA
05
—
1526217
—
TN
05
—
7100188700
—
KY
01
—
P01050137
RR MEDICARE
TN
Enumeration date
07/09/2008
Last updated
05/02/2020
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