Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 35085038 | OH |
Y | 208800000X | Urologist | 35085038 | OH |
NPI | 1568552644 |
---|---|
Provider Name | Courtenay K Moore |
First Address | Columbus, OH 43202-1559 |
Second Address | Columbus, OH 43212-3153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2583575 | (05) | OH |
I19296 | (02) | OH |