Provider Demographics
NPI:1437671377
Name:GENE MOORE MD P LLC
Entity Type:Organization
Organization Name:GENE MOORE MD P LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-864-7080
Mailing Address - Street 1:28 S WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3486
Mailing Address - Country:US
Mailing Address - Phone:802-864-7080
Mailing Address - Fax:802-863-0411
Practice Address - Street 1:28 SO WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-864-7080
Practice Address - Fax:802-863-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042010189207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00058102OtherBLUE CROSS BLUE SHIELD
VTOVN2573Medicaid