Provider Demographics
NPI:1952452260
Name:MOORE, PAULA D (M D)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:D
Last Name:MOORE
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 ROCKY RIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2833
Mailing Address - Country:US
Mailing Address - Phone:205-286-3200
Mailing Address - Fax:205-286-3201
Practice Address - Street 1:2470 ROCKY RIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-2833
Practice Address - Country:US
Practice Address - Phone:205-286-3200
Practice Address - Fax:205-286-3201
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF08839Medicare UPIN
M33283Medicare ID - Type Unspecified