Individual
PAUL DEREK MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 CUMBERLAND ST, SUITE 205, LEBANON, PA 17042-5266
(717) 277-7400
(717) 277-7402
Mailing address
100 N CAMERON ST, SUITE 401E, HARRISBURG, PA 17101-2424
(717) 232-8535
(717) 232-8515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
40759
CO
208D00000X
General Practice Physician
Primary
MD444618
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09932861
—
CO
Enumeration date
10/11/2005
Last updated
09/23/2016
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