Individual
MARK TILLMAN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
890 W FARIS RD, SUITE 330, GREENVILLE, SC 29605-4247
(864) 233-1112
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6044
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
15206
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152069
—
SC
01
—
1569106
CIGNA
SC
01
—
4602405
AETNA
SC
01
—
57-1004971032
BCBS OF SC
SC
01
—
P00713069
RR MEDICARE
SC
Enumeration date
06/29/2006
Last updated
08/23/2013
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