Provider Demographics
NPI:1841309952
Name:MOORE, RICHARD EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EUGENE
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 1:3040 WESTOVER DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8872
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:523 HARKRIDER ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032
Practice Address - Country:US
Practice Address - Phone:501-504-6959
Practice Address - Fax:501-327-5963
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35984207LP2900X, 207LP2900X
ARE9341207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5BG40OtherARKANSAS BLUE CROSS
P01625775OtherRAILROAD MEDICARE
MO105181OtherBLUE CROSS BLUE SHIELD
MOMA6957001OtherMEDICARE PART B
MO201580115Medicaid
178136OtherHEALTHLINK
4691938OtherAETNA
IL0280378073Medicaid
178136OtherHEALTHLINK