Provider Demographics
NPI:1013975085
Name:MOORES, HAROLD III (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:MOORES
Suffix:III
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:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-0271
Mailing Address - Country:US
Mailing Address - Phone:231-775-6076
Mailing Address - Fax:231-775-0027
Practice Address - Street 1:440 COBB ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2542
Practice Address - Country:US
Practice Address - Phone:231-775-6076
Practice Address - Fax:231-775-0027
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057697207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104400127Medicaid
MI0F71000OtherBCBS
MI104134503Medicaid
MI104744745Medicaid
MI104400127Medicaid
MI104744745Medicaid
MI104134503Medicaid