Individual
MATTHEW D MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1911 N FAIRFIELD RD, STE 110, BEAVERCREEK, OH 45432-2762
(937) 429-4369
(937) 429-4575
Mailing address
1911 N FAIRFIELD RD, STE 110, BEAVERCREEK, OH 45432-2762
(937) 429-4369
(937) 429-4575
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35055799M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000281392
ANTHEM
—
05
—
0671983
—
OH
01
—
2060101
UHC
—
Enumeration date
08/31/2006
Last updated
02/13/2013
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