Provider Demographics
NPI:1801403118
Name:MOORE, ALEC (RD, LD)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 ROBERTSON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1213
Mailing Address - Country:US
Mailing Address - Phone:937-733-3871
Mailing Address - Fax:
Practice Address - Street 1:2813 ROBERTSON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1213
Practice Address - Country:US
Practice Address - Phone:937-733-3871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09254133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered