Provider Demographics
NPI:1184646473
Name:MOORE, KENNETH DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DAVID
Last Name:MOORE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SAINT VINCENTS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1638
Mailing Address - Country:US
Mailing Address - Phone:205-939-3699
Mailing Address - Fax:205-484-2585
Practice Address - Street 1:805 SAINT VINCENTS DR STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1638
Practice Address - Country:US
Practice Address - Phone:205-939-3699
Practice Address - Fax:205-484-2585
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24165207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000025579OtherBLUE CROSS
AL009966070Medicaid
AL000025579Medicaid
AL051503536OtherBLUE CROSS
AL051511207OtherBLUE CROSS
AL051529536OtherBLUE CROSS
AL051503535Medicaid
AL009931891Medicaid
AL051503535OtherBLUE CROSS
AL009966070Medicaid
AL020049904Medicare PIN