Olyn Fred Moore III, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD012164 Issued in TN

Practice address

503 Tickle Street
Dyersburg, TN 38024

Phone

(731) 285-5244

Fax

(731) 285-8970

NPI assigned

Apr 6, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• O Fred Moore III MD PC

  dba Drs James A Caylor & O Fred Moore III

  • Surgery Physician
  • Dyersburg, TN
  • NPI 1720208242
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532995200000",
    "number": "1245293828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 TICKLE STREET",
            "address_2": "SUITE #1",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "38024",
            "telephone_number": "731-285-5244",
            "fax_number": "731-285-8970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 TICKLE STREET",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "38024",
            "telephone_number": "731-285-5244",
            "fax_number": "731-285-8970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "OLYN",
        "middle_name": "FRED",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2018-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "MD012164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNCARE UNISOM",
            "identifier": "117022",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3008574",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "2003420",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Miracles Network Agency
• Janet S.. Monroe, R.N.
• Molly Moody, SLP
• Donna K Moore
• Leslie Corinne Moore, LPC
• Ramakant Mahadeo Mulay, MD
• Shree Ramakant Mulay, MD
• Laura M Mulvany, SLP
• Alyssa Murdock
• Blake Murphy, PTA

• Surgery Physician in Dyersburg, TN
• Providers in Dyersburg, TN by specialty
• Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.