Provider Demographics
NPI:1912298076
Name:MOISE, EPHESE (MD)
Entity Type:Individual
Prefix:DR
First Name:EPHESE
Middle Name:
Last Name:MOISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EPHESE
Other - Middle Name:
Other - Last Name:MOISE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-301-8074
Mailing Address - Fax:859-301-4945
Practice Address - Street 1:4900 HOUSTON RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4824
Practice Address - Country:US
Practice Address - Phone:859-301-8074
Practice Address - Fax:859-301-4945
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45043207Q00000X, 208M00000X
IN01086572A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100204020Medicaid
KY7100204020Medicaid