Provider Demographics
NPI:1235211616
Name:MOORE, THOMAS JAMES (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:80 HOSPITAL DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7363
Mailing Address - Country:US
Mailing Address - Phone:606-545-4460
Mailing Address - Fax:606-545-4469
Practice Address - Street 1:1317 CUMBERLAND FALLS HWY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2720
Practice Address - Country:US
Practice Address - Phone:606-620-4153
Practice Address - Fax:606-523-3895
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY22596207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6422596400Medicaid
KY000000503392OtherBCBS OF KY
KY6422596400Medicaid
KY00190001Medicare PIN