Provider Demographics
NPI:1902831662
Name:MOORE, WILLIAM FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FRANCIS
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 1:4620 S LABURNUM AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-2424
Mailing Address - Country:US
Mailing Address - Phone:804-652-2200
Mailing Address - Fax:804-222-0458
Practice Address - Street 1:4620 S LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-2424
Practice Address - Country:US
Practice Address - Phone:804-652-2200
Practice Address - Fax:804-222-0458
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA393518OtherMAMSI
VA4110558OtherAETNA HMO
VA4110558OtherAETNA LIFE
VA45894OtherSENTARA
VA79146OtherSOUTHERN HEALTH SERVICES
VA010061114OtherRAILROAD MEDICARE
VA2675239OtherCIGNA
VA005621275Medicaid
VA204505OtherANTHEM BCBS OF VA
VA2675239OtherCIGNA
VA204505OtherANTHEM BCBS OF VA