Provider Demographics
NPI:1629038609
Name:MOORE, CHARLES EDWARD JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2407 HELTON DR STE B
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1067
Mailing Address - Country:US
Mailing Address - Phone:256-718-7001
Mailing Address - Fax:256-718-7006
Practice Address - Street 1:2407 HELTON DR STE B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1067
Practice Address - Country:US
Practice Address - Phone:256-764-9613
Practice Address - Fax:256-764-8474
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL15163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051501284Medicaid
AL051501284Medicare ID - Type UnspecifiedMEDICARE
AL051501284Medicaid