Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 00273 | KY |
Y | 222Z00000X | Podiatrist | 00273 | KY |
N | 213EP0504X | Public Medicine | 00273 | KY |
N | 213EP1101X | Primary Podiatric Medicine | 00273 | KY |
N | 111NR0200X | Radiology | 00273 | KY |
N | 213ER0200X | Radiology | 00273 | KY |
N | 2081S0010X | Sports Medicine | 00273 | KY |
N | 213ES0000X | Sports Medicine | 00273 | KY |
N | 213ES0103X | Foot & Ankle Surgery | 00273 | KY |
N | 213ES0131X | Foot Surgery | 00273 | KY |
NPI | 1912048992 |
---|---|
Provider Name | Dr. Christopher Bryan Moore |
First Address | Ashland, KY 41102-9516 |
Second Address | Ashland, KY 41102-9516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2007 |
Last Update Date | 01/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000216342 | ANTHEM BC AND BS (01) | KY |
371421256 | TAX IDENTIFICATION NUMBER (01) | KY |
7774351 | AETNA US HEALTHCARE (01) | KY |
U80502 | (02) | KY |