Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 36541 | TN |
N | 208200000X | Surgeon | 36541 | TN |
N | 208600000X | Surgeon | 36541 | TN |
N | 208200000X | Surgeon | MD428381 | PA |
N | 208600000X | Surgeon | MD428381 | PA |
NPI | 1376697391 |
---|---|
Provider Name | Derek Moore |
First Address | Nashville, TN 37203-5180 |
Second Address | Nashville, TN 37205-2094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 15/12/2020 |