Provider Demographics
NPI:1265405039
Name:MOODY, THOMAS E (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:MOODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3485 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5603
Mailing Address - Country:US
Mailing Address - Phone:205-930-0920
Mailing Address - Fax:205-445-0115
Practice Address - Street 1:3485 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-5603
Practice Address - Country:US
Practice Address - Phone:205-930-0920
Practice Address - Fax:205-445-0115
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00007582208800000X
AL7582207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC76475OtherVIVA
AL009940577Medicaid
AL0366100001OtherMC NSC
AL2652937001OtherCIGNA
AL4288415OtherAETNA
AL000037357OtherMEDICARE PTAN
AL000025362OtherMEDICARE PTAN
AL1910076OtherUNITED HEALTHCARE
AL0366100001OtherCIGNA GOVERNMENT SERVICES PTAN
AL1910032OtherUNITED HEALTHCARE
ALC76475OtherHEALTH SPRINGS
AL4288415OtherAETNA
ALC76475OtherHEALTH SPRINGS