Individual
DR. JOHN P. MOORE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1118 ROSS CLARK CIR, STE 310, DOTHAN, AL 36301-3002
(334) 793-1534
(334) 793-6991
Mailing address
1118 ROSS CLARK CIR, STE 310, DOTHAN, AL 36301-3002
(334) 793-1534
(334) 793-6991
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
9967
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000015068
AL BLUECROSS BLUESHIELD #
AL
05
—
000015068
—
AL
Enumeration date
06/17/2005
Last updated
12/30/2009
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