Basic Information
| Provider Information | |||||||||
| NPI: | 1427035104 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MOORE CLINIC FOR WHOLENESS IN HEALTH, P.A. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 70211 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366701211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513682550 | ||||||||
| FaxNumber: | 2514765460 | ||||||||
| Practice Location | |||||||||
| Address1: | 408 MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | ATMORE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365023016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514765443 | ||||||||
| FaxNumber: | 2514765460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2005 | ||||||||
| LastUpdateDate: | 08/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | I. | ||||||||
| AuthorizedOfficialMiddleName: | HARRISON | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2513682550 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.