Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 02001 | KY |
NPI | 1609099100 |
---|---|
Provider Name | Daniel Bailey Moore |
First Address | Versailles, KY 40383-1468 |
Second Address | Versailles, KY 40383-1468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 21/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64020019 | (05) | KY |
C69521 | (02) |