Individual
DAVID CARSON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
316 VILLAGE CREEK DR, BOILING SPRINGS, SC 29316-5387
(864) 327-9003
Mailing address
316 VILLAGE CREEK DR, BOILING SPRINGS, SC 29316-5387
(864) 327-9003
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
MPA3438
SC
208000000X
Pediatrics Physician
MPA3438
SC
2080A0000X
Pediatric Adolescent Medicine Physician
MPA3438
SC
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4061PA
—
SC
01
—
SCG9716084
MEDICARE PIN
SC
01
—
SCG971J577
MEDICARE PIN
SC
01
—
SCG971J6067
MEDICARE PIN
SC
Enumeration date
09/07/2019
Last updated
01/30/2023
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