Provider Demographics
NPI:1174746713
Name:MOORE, HUGH D (PHD)
Entity type:Individual
Prefix:DR
First Name:HUGH
Middle Name:D
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5366 ESTATE OFFICE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0611
Mailing Address - Country:US
Mailing Address - Phone:901-454-9233
Mailing Address - Fax:901-881-0674
Practice Address - Street 1:5366 ESTATE OFFICE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0611
Practice Address - Country:US
Practice Address - Phone:901-454-9233
Practice Address - Fax:901-881-0674
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2682103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I622930Medicaid