Provider Demographics
NPI:1740270016
Name:MOORE, KEVIN E (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:E
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7835
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:4371 NEW SHEPHERDSVILLE RD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-8040
Practice Address - Country:US
Practice Address - Phone:502-350-1022
Practice Address - Fax:502-350-1023
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2025-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYKY 33047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100471590Medicaid