Individual
CAROLYN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
155 BRICKLAYER STREET, OLIVE HILL, KY 41164
(606) 286-4152
(606) 286-2385
Mailing address
PO BOX 1268, OLIVE HILL, KY 41164-1268
(606) 286-4152
(606) 286-2385
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30072
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080069346
RAILROAD MEDICARE
KY
01
—
080077589
RAILROAD MEDICARE
KY
01
—
080096401
RAILROAD MEDICARE
KY
01
—
080099911
RAILROAD MEDICARE
KY
01
—
080104514
RAILROAD MEDICARE
KY
05
—
64300726
—
KY
Enumeration date
11/07/2005
Last updated
09/22/2015
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