Provider Demographics
NPI:1740274158
Name:MOORE, THOMAS SAUNDERS (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SAUNDERS
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 1:2055 NORMANDIE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2732
Mailing Address - Country:US
Mailing Address - Phone:334-288-4624
Mailing Address - Fax:334-280-3628
Practice Address - Street 1:2055 NORMANDIE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2732
Practice Address - Country:US
Practice Address - Phone:334-288-4624
Practice Address - Fax:334-280-3628
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000172672085R0202X, 2085R0204X
FLME417032085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009945535Medicaid
AL107078Medicaid
AL108201Medicaid
AL000045271Medicaid
AL107076Medicaid
AL000058867OtherIDTF
FL270023900Medicaid
AL009931135Medicaid
AL009945555Medicaid
AL000045269Medicaid
AL000085892Medicaid
AL051504364OtherIDTF
AL009931145Medicaid
AL000045268Medicaid
AL009945545Medicaid
AL009951055Medicaid
AL108078Medicaid
AL108201Medicaid
AL108078Medicaid
AL051504364OtherIDTF
FL270023900Medicaid
AL009945535Medicaid
AL000045268Medicaid