Basic Information
| Provider Information | |||||||||
| NPI: | 1740274158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | SAUNDERS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2055 NORMANDIE DR | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361112732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342884624 | ||||||||
| FaxNumber: | 3342803628 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 NORMANDIE DR | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361112732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342884624 | ||||||||
| FaxNumber: | 3342803628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 11/02/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 00017267 | AL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | ME41703 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 00017267 | AL | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0204X | ME41703 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 009945535 | 05 | AL | MEDICAID | 107078 | 05 | AL | MEDICAID | 108201 | 05 | AL | MEDICAID | 000045271 | 05 | AL | MEDICAID | 107076 | 05 | AL | MEDICAID | 000058867 | 01 | AL | IDTF | OTHER | 270023900 | 05 | FL | MEDICAID | 009931135 | 05 | AL | MEDICAID | 009945555 | 05 | AL | MEDICAID | 000045269 | 05 | AL | MEDICAID | 000085892 | 05 | AL | MEDICAID | 051504364 | 01 | AL | IDTF | OTHER | 009931145 | 05 | AL | MEDICAID | 000045268 | 05 | AL | MEDICAID | 009945545 | 05 | AL | MEDICAID | 009951055 | 05 | AL | MEDICAID | 108078 | 05 | AL | MEDICAID |