Provider Demographics
NPI:1285668699
Name:MOORE, PAUL BEVERIDGE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BEVERIDGE
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 241587
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-1587
Mailing Address - Country:US
Mailing Address - Phone:334-280-1500
Mailing Address - Fax:334-280-1600
Practice Address - Street 1:273 WINTON M BLOUNT LOOP
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3507
Practice Address - Country:US
Practice Address - Phone:334-280-1500
Practice Address - Fax:334-280-1600
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11047207RC0000X, 207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL17844Medicaid
AL11047OtherMEDICAL LICENSE
AL051007015OtherBLUE SHIELD PROVIDER #
AL051017844OtherBLUE SHIELD PROVIDER #
AL051017844OtherBLUE SHIELD PROVIDER #
C73783Medicare UPIN
AL17844Medicaid