Provider Demographics
NPI:1407855968
Name:MOORE, WILLIAM SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SCOTT
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:730 HIGHLAND OAKS DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-7108
Mailing Address - Country:US
Mailing Address - Phone:336-768-2425
Mailing Address - Fax:336-768-4915
Practice Address - Street 1:730 HIGHLAND OAKS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7108
Practice Address - Country:US
Practice Address - Phone:336-768-2425
Practice Address - Fax:336-768-4915
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23953207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC60539OtherBCBS
NC8960539Medicaid
NC8960539Medicaid
NCC85634Medicare UPIN