Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35.059285 | OH |
N | 207QA0505X | Family Doctor - Adult Medicine | 39431 | KY |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 39431 | KY |
N | 207QS0010X | Family Doctor - Sports Medicine | 39431 | KY |
NPI | 1164534855 |
---|---|
Provider Name | David Julius Moore |
First Address | Chillicothe, OH 45601-0188 |
Second Address | Mc Arthur, OH 45651-9006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 31/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64104524 | (05) | KY |
E91880 | (02) |