Individual
MR. BRADLEY T MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
62 KY RTE 306, BYPRO, KY 41612
(606) 452-1700
(606) 452-1703
Mailing address
62 KY RTE 306, BYPRO, KY 41612
(606) 452-1700
(606) 452-1703
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02916
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64106719
—
KY
Enumeration date
09/02/2005
Last updated
08/13/2024
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