Provider Demographics
NPI:1851308332
Name:MOORE, DAVID PRINGLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PRINGLE
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 1:402 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4040
Mailing Address - Country:US
Mailing Address - Phone:502-552-4633
Mailing Address - Fax:502-895-7997
Practice Address - Street 1:402 BROWNS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4040
Practice Address - Country:US
Practice Address - Phone:502-552-4633
Practice Address - Fax:502-895-7997
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY193072084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01669282OtherRAILROAD MEDICARE
KY000000248358OtherANTHEM
IN100027390Medicaid
KY64193071Medicaid
KY64193071Medicaid