Individual
DEREK RONALD MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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