Provider Demographics
NPI:1013061860
Name:JEFFREY A. MOORE, INC
Entity Type:Organization
Organization Name:JEFFREY A. MOORE, INC
Other - Org Name:JEFFREY ALAN MOORE, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-276-7727
Mailing Address - Street 1:PO BOX 1889
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28353-1889
Mailing Address - Country:US
Mailing Address - Phone:910-276-7727
Mailing Address - Fax:910-277-7439
Practice Address - Street 1:601 E LAUCHWOOD DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5510
Practice Address - Country:US
Practice Address - Phone:910-276-7727
Practice Address - Fax:910-277-7439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31595207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914360Medicaid
SCNPA788Medicaid
NC5914360Medicaid
SCNPA788Medicaid