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Contact Information

JACK C MOORE II, MD
175 S ENGLISH STATION RD STE 226
LOUISVILLE, KY40245
 Phone: 502-244-0911
 Fax: 502-253-0581
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for JACK C MOORE II · (Male)

NPI # 1164443529
Status Active
Credentials MD
Entity Individual
Enumeration date 07/21/2006
Last updated 08/19/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 01069727A
  • KY License # 34365
  • KY Medicaid 64040173
  • KY Other P01073440 MEDICARE RAILROAD
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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