Provider Demographics
NPI:1659315067
Name:MOORE, NOEL T (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:T
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 1:1 CAYLOR NICKEL SQ
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-2529
Mailing Address - Country:US
Mailing Address - Phone:260-824-3500
Mailing Address - Fax:260-919-3419
Practice Address - Street 1:1 CAYLOR NICKEL SQ
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2529
Practice Address - Country:US
Practice Address - Phone:260-824-3500
Practice Address - Fax:260-919-3419
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01029517A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100331210Medicaid
IN911080G4Medicare ID - Type Unspecified
IN100331210Medicaid