Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 10002 | SC |
NPI | 1184671158 |
---|---|
Provider Name | Edward E Moore |
First Address | Columbia, SC 29201 |
Second Address | Columbia, SC 29201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D18224 | (02) | |
G03136 | (05) | SC |