Provider Demographics
NPI:1700804242
Name:MOORE, WILLIAM HARRISON JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HARRISON
Last Name:MOORE
Suffix:JR
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 1:3368 HIGHWAY 280
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3393
Mailing Address - Country:US
Mailing Address - Phone:256-234-3477
Mailing Address - Fax:256-234-9866
Practice Address - Street 1:3368 HIGHWAY 280
Practice Address - Street 2:SUITE 111
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3393
Practice Address - Country:US
Practice Address - Phone:256-234-3477
Practice Address - Fax:256-234-9866
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15177207VG0400X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00002851MOOMedicaid
AL51119786OtherBLUE CROSS/BLUE SHIEL
AL00002851MOOMedicaid
ALF00366Medicare UPIN