Provider Demographics
NPI:1205815214
Name:MOORE, MICHAEL ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ARTHUR
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0777
Mailing Address - Country:US
Mailing Address - Phone:205-481-7670
Mailing Address - Fax:205-481-7573
Practice Address - Street 1:927 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-6081
Practice Address - Country:US
Practice Address - Phone:205-481-8670
Practice Address - Fax:205-424-4927
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009941417Medicaid
AL051005021OtherBLUE CROSS
AL051005021OtherBLUE CROSS
AL051558192Medicare ID - Type Unspecified