Provider Demographics
NPI:1972667665
Name:MOORE, D SCOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:D SCOTT
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST VINCENTS EMERGENCY PHYSICIANS INC 4685 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0046
Mailing Address - Country:US
Mailing Address - Phone:317-802-3140
Mailing Address - Fax:317-870-6719
Practice Address - Street 1:2001 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1902
Practice Address - Country:US
Practice Address - Phone:317-802-3140
Practice Address - Fax:317-870-0499
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1039207P00000X
IN02002731A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01182507OtherAMERIGROUP
IN300025719Medicaid
GA483409800DMedicaid
SCO10393Medicaid
GA483409800CMedicaid
AL009976045Medicaid
SC483409800Medicaid
GA483409800BMedicaid
AL009976045Medicaid
SCI040198055Medicare PIN
GA01182507OtherAMERIGROUP
SCO10393Medicaid
GA483409800BMedicaid