Provider Demographics
NPI:1679889166
Name:MOORE, GREGORY L JR (PA-C)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1237
Mailing Address - Country:US
Mailing Address - Phone:606-326-1675
Mailing Address - Fax:606-326-1436
Practice Address - Street 1:2301 LEXINGTON AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2873
Practice Address - Country:US
Practice Address - Phone:606-326-1675
Practice Address - Fax:606-326-1436
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant