Provider Demographics
NPI:1659327864
Name:MOORE, LEANN RUTH DEAL (MD)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:RUTH DEAL
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:RUTH
Other - Last Name:DEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12248
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2248
Mailing Address - Country:US
Mailing Address - Phone:252-636-2664
Mailing Address - Fax:252-636-8305
Practice Address - Street 1:3252 WELLONS BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5234
Practice Address - Country:US
Practice Address - Phone:252-636-2664
Practice Address - Fax:252-636-8305
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8960376Medicaid
NC60376OtherBCBS OF NC
NC080114252Medicare PIN
NC2151270BMedicare PIN
NC8960376Medicaid
NC8960376Medicaid