Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 15177 | AL |
Y | 207VG0400X | Gynecologist | 15177 | AL |
NPI | 1700804242 |
---|---|
Provider Name | William Harrison Moore JR. |
First Address | Alexander City, AL 35010-3393 |
Second Address | Alexander City, AL 35010-3393 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 10/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00002851MOO | (05) | AL |
51119786 | BLUE CROSS/BLUE SHIEL (01) | AL |
F00366 | (02) | AL |