Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | TP916 | KY |
NPI | 1013206721 |
---|---|
Provider Name | James Daniel Moore |
First Address | Lexington, KY 40536-0298 |
Second Address | Lexington, KY 40536-0298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2011 |
Last Update Date | 12/08/2015 |