Individual
EVAN MICHAEL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1401 HARRODSBURG RD STE B75, LEXINGTON, KY 40504-1724
(859) 276-3883
Mailing address
1401 HARRODSBURG RD STE B75, LEXINGTON, KY 40504-1724
(859) 276-3883
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
52794
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100324190
—
KY
Enumeration date
04/25/2013
Last updated
11/14/2019
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