Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0002X | Hospice and Palliative Medicine | 35067263 | OH |
Y | 207RX0202X | Medical Oncology | 35067263 | OH |
NPI | 1144278243 |
---|---|
Provider Name | Timothy Moore |
First Address | Atlanta, GA 30368-7287 |
Second Address | Columbus, OH 43219-1530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 14/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000118593 | ANTHEM BC/BS (01) | OH |
0835878 | (05) | OH |
3600169 | UNITED HEALTHCARE (01) | OH |
E83721 | (02) | OH |