Individual
GRACE D. MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2307 GREENE WAY, LOUISVILLE, KY 40220-4009
(502) 897-9594
(502) 736-4456
Mailing address
PO BOX 950251, LOUISVILLE, KY 40295-0251
(502) 897-9594
(502) 736-4456
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
37065
KY
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
37065
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200445300
MEDICAID
IN
05
—
64-074552
—
KY
Enumeration date
12/22/2005
Last updated
07/29/2009
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