Provider Demographics
NPI:1467684621
Name:MOORE, SAMUEL ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ARTHUR
Last Name:MOORE
Suffix:
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 1:501 20TH ST
Mailing Address - Street 2:STE 503
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1809
Mailing Address - Country:US
Mailing Address - Phone:865-541-4321
Mailing Address - Fax:865-541-4320
Practice Address - Street 1:501 20TH ST
Practice Address - Street 2:STE 503
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1809
Practice Address - Country:US
Practice Address - Phone:865-541-4321
Practice Address - Fax:865-541-4320
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN512042084N0400X, 2084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
TNQ006336Medicaid
MN130001530Medicare PIN
TN103I137207Medicare PIN