Provider Demographics
NPI:1639267784
Name:MOORE, TANIKQUA DENYALE (MD)
Entity Type:Individual
Prefix:DR
First Name:TANIKQUA
Middle Name:DENYALE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 CAHABA RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2623
Mailing Address - Country:US
Mailing Address - Phone:205-769-0653
Mailing Address - Fax:205-769-0657
Practice Address - Street 1:3300 CAHABA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35223-2623
Practice Address - Country:US
Practice Address - Phone:205-769-0653
Practice Address - Fax:205-769-0657
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28699208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program