Provider Demographics
NPI:1346244076
Name:MOORE, RAY JEMISON III (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:JEMISON
Last Name:MOORE
Suffix:III
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 1:2904 WESTCORP BLVD SW
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-6437
Mailing Address - Country:US
Mailing Address - Phone:256-533-1480
Mailing Address - Fax:256-536-4158
Practice Address - Street 1:2904 WESTCORP BLVD SW
Practice Address - Street 2:SUITE 107/108
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-6437
Practice Address - Country:US
Practice Address - Phone:256-533-1480
Practice Address - Fax:256-536-4158
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20131207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051094264OtherBCBS
AL009927350Medicaid
ALH11637Medicare UPIN
AL009927350Medicaid