Provider Demographics
NPI:1396205605
Name:MOORE, SHAWN E (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:E
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 E. TOWN ST.
Mailing Address - Street 2:#116
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215
Mailing Address - Country:US
Mailing Address - Phone:614-566-9108
Mailing Address - Fax:614-566-9110
Practice Address - Street 1:GRANT MEDICAL CENTER SURGICAL CRITICAL CARE
Practice Address - Street 2:393 E. TOWN ST. #116
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-566-9108
Practice Address - Fax:614-566-9110
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program