Provider Demographics
NPI:1821081472
Name:MOORE, WAYNE E (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:E
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 QUAIL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5806
Mailing Address - Country:US
Mailing Address - Phone:615-566-6188
Mailing Address - Fax:615-837-4514
Practice Address - Street 1:1818 ALBION ST
Practice Address - Street 2:METROPOLITAN NASHVILLE GENERAL HOSPITAL EMERGENCY DEPT
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-2918
Practice Address - Country:US
Practice Address - Phone:615-341-4000
Practice Address - Fax:615-837-4514
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26654207PE0004X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4090137OtherBCBS
TN3839393Medicaid
C89285Medicare UPIN
TN3839393Medicaid