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Organization

MATTHEW D MOORE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MATTHEW D MOORE M.D. (OWNER)
(937) 429-9683
Entity
Organization

Contact information

Practice address
2141 NORTH FAIRFIELD ROAD, SUITE C, BEAVERCREEK, OH 45431-2579
(937) 429-9683
(937) 429-9729
Mailing address
2141 NORTH FAIRFIELD ROAD, SUITE C, BEAVERCREEK, OH 45431-2579
(937) 429-9683
(937) 429-9729

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
OH
05
0671983
OH
01
2060101
UHC
OH
Enumeration date
10/31/2007
Last updated
10/31/2007
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