Individual
DEREK RONALD MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
655 JESSE JEWELL PKWY SE, STE B, GAINESVILLE, GA 30501-3854
(770) 532-7092
(770) 536-0383
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 535-7445
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
054090
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0901538
UHC
GA
01
—
10062471
AMERIGROUP
GA
05
—
203604041C
—
GA
05
—
203604041D
—
GA
01
—
342650
WELLCARE
GA
01
—
4599810
CIGNA
GA
01
—
52703247
BCBS
GA
01
—
7851732
AETNA
GA
01
—
P00349858
RR MEDICARE-GRP # CC4177
GA
Enumeration date
07/26/2006
Last updated
08/15/2011
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