Provider Demographics
NPI:1609943703
Name:MOORE, LILY LEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:LILY
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1719
Mailing Address - Country:US
Mailing Address - Phone:828-350-1880
Mailing Address - Fax:828-252-2272
Practice Address - Street 1:136 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1719
Practice Address - Country:US
Practice Address - Phone:828-350-1880
Practice Address - Fax:828-252-2272
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC477213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
08088OtherBCBS
NC8908088Medicaid
2433675AMedicare ID - Type Unspecified
NC8908088Medicaid