Individual
EDWARD N MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 MARY ST., SUITE 230, EVANSVILLE, IN 47710-1678
(812) 464-9133
(812) 464-0559
Mailing address
4015 GATEWAY BLVD, SUITE 2120, NEWBURGH, IN 47630-9460
(812) 842-0907
(812) 464-4485
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
01037835A
IN
207RC0000X
Cardiovascular Disease Physician
26955
KY
207RI0011X
Interventional Cardiology Physician
Primary
01037835A
IN
207RI0011X
Interventional Cardiology Physician
26955
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042540
ANTHEM
—
01
—
0255503
MEDICARE
KY
05
—
100343980A
—
IN
01
—
532500I
MEDICARE
IN
05
—
64870405
—
KY
01
—
L22370
MEDICARE
IL
Enumeration date
04/12/2006
Last updated
04/13/2016
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