Individual
CLARK D MOORE III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
191 CENTRE SOUTH BLVD, SUITE 10, AIKEN, SC 29803-6313
(803) 335-2281
(803) 937-1706
Mailing address
191 CENTRE SOUTH BLVD, SUITE 10, AIKEN, SC 29803-6313
(803) 335-2281
(803) 937-1706
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
10145
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101455
—
SC
01
—
57-0724225
TAX ID
SC
Enumeration date
01/30/2006
Last updated
01/06/2017
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