Provider Demographics
NPI:1801880620
Name:MOORE, RUFUS WILLIAM JR (MD)
Entity type:Individual
Prefix:DR
First Name:RUFUS
Middle Name:WILLIAM
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:650 JOEL DR
Mailing Address - Street 2:BLANCHFIELD ARMY COMMUNITY HOSPITAL,RM3CB39
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5318
Mailing Address - Country:US
Mailing Address - Phone:270-798-8400
Mailing Address - Fax:270-956-0180
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:BLANCHFIELD ARMY COMMUNITY HOSPITAL,RM3CB39
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-798-8400
Practice Address - Fax:270-956-0180
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2009-12-08
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-12-31
Provider Licenses
StateLicense IDTaxonomies
CAA031507207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYA26509Medicare UPIN