Individual
MR. DAVID WENDELL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
101 PROSPEROUS PL STE 300, LEXINGTON, KY 40509-1836
(859) 275-5229
(859) 977-2683
Mailing address
PO BOX 21890, BELFAST, ME 04915-4115
(502) 907-0356
(502) 919-9780
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA347
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000299029
ANTHEM PIN
KY
01
—
11368446
CAQH PROVIDER ID
—
01
—
1468559
WELLCARE OF KY PROVIDER ID NUMBER
KY
01
—
164291500
DEPARTMENT OF LABOR
KY
05
—
300009771
—
IN
01
—
611369666
HUMANA PIN
KY
01
—
7085548
AETNA PIN
—
01
—
84555KYIP
AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
KY
05
—
95003471
—
KY
01
—
CS1801900158
CARESOURCE ID
—
Enumeration date
05/24/2006
Last updated
06/09/2022
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