Provider Demographics
NPI:1205896826
Name:MOORE, JOHN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:SUITE B488
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-276-3883
Mailing Address - Fax:859-276-3855
Practice Address - Street 1:1401 HARRODSBURG RD STE B75
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:859-276-3883
Practice Address - Fax:859-276-3855
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2018-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY20795208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64207954Medicaid
0309103Medicare PIN
C75859Medicare UPIN