Provider Demographics
NPI:1922099753
Name:DRS GLOVER AND MOORE PC
Entity Type:Organization
Organization Name:DRS GLOVER AND MOORE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:276-628-5711
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212
Mailing Address - Country:US
Mailing Address - Phone:276-628-6011
Mailing Address - Fax:276-628-3923
Practice Address - Street 1:HOSPITAL DRIVE GLENROCHIE PROFESSIONAL BLDG
Practice Address - Street 2:SUITE 200
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210
Practice Address - Country:US
Practice Address - Phone:276-628-6011
Practice Address - Fax:276-628-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101025906207V00000X
VA0101235032207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA385300OtherANTHEM
B06839Medicare UPIN
C08321Medicare ID - Type Unspecified
E31259Medicare UPIN