Bennie  N  Moore    MD
Contract Details
Facility name
Provider ID
P000001185
Tax ID
631262749
Effective Date
1/4/1993
Last Updated
4/25/2013
Direct Contract
Yes
Term Date
4/25/2013
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
2828 Highway 31 South
Decatur, AL 35603
United States
County
Morgan
Phone
2563532000 (Phone)
Billing Details
Address
Specialty Type
General Practice
Map
Address