Individual
TED MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1700 RING RD, ELIZABETHTOWN, KY 42701-9497
(270) 769-5551
(270) 765-3919
Mailing address
1700 RING RD, ELIZABETHTOWN, KY 42701-9497
(270) 769-5551
(270) 765-3919
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
24016
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000045856
ANTHEM BCBS
KY
01
—
1048776
PASSPORT
KY
05
—
64240161
—
KY
Enumeration date
07/19/2005
Last updated
02/25/2008
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