Individual
DR. SCOTT MACLEOD MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301073339
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024175
MIDWEST HP-MEDICAID
MI
01
—
1220066
PHP
MI
01
—
201711014
TRICARE
MI
01
—
3508144121
BCBS-INDIVIDUAL
MI
05
—
4689652
—
MI
01
—
5526527
AENTA
MI
01
—
6U4708
HAP
—
01
—
OH11422
BCBS/BCN GROUP
—
Enumeration date
05/22/2006
Last updated
08/07/2025
Update your record
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