Provider Demographics
NPI:1861490476
Name:MOORE, SCOTT GARNER (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:GARNER
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 1:174 HIGHWAY 113
Mailing Address - Street 2:
Mailing Address - City:FLOMATON
Mailing Address - State:AL
Mailing Address - Zip Code:36441-4556
Mailing Address - Country:US
Mailing Address - Phone:251-296-2456
Mailing Address - Fax:251-296-2400
Practice Address - Street 1:174 HIGHWAY 113
Practice Address - Street 2:
Practice Address - City:FLOMATON
Practice Address - State:AL
Practice Address - Zip Code:36441-4556
Practice Address - Country:US
Practice Address - Phone:251-296-2456
Practice Address - Fax:251-296-2400
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38679207Q00000X
FL115576207Q00000X
AL34200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL148029Medicaid
KY000000326872OtherBCBS PROVIDER ID
KY1213053OtherCHA PROVIDER ID
KY64075468Medicaid
FL008455000Medicaid
KY35001700Medicaid
KY000000326872OtherBCBS PROVIDER ID
AL148029Medicaid
K038590Medicare PIN
AL148029Medicaid