Provider Demographics
NPI:1780644906
Name:MOORE, LLOYD DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:DAVID
Last Name:MOORE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:606-330-7840
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:170 PEDRO WAY
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-8354
Practice Address - Country:US
Practice Address - Phone:859-901-1122
Practice Address - Fax:859-276-5939
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA 380363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95000410Medicaid
KY95000410Medicaid
KYP400015572Medicare PIN
KYK009431Medicare PIN
KYP100017044Medicare PIN