Individual
DR. LANE INGRAM MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
845 82ND PKWY, MYRTLE BEACH, SC 29572-4614
(843) 449-9621
Mailing address
845 82ND PKWY, MYRTLE BEACH, SC 29572-4614
(843) 449-9621
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
22109
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221094
—
SC
01
—
67728
MEDCOST
—
05
—
89063Y4
—
NC
Enumeration date
05/03/2006
Last updated
07/18/2011
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