MEDICARE: REMIS MARK MOORE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA9117098	OTHER	FL	FL DOH LICENSE

General Provider Information

NPI Number	:	1588653794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REMIS MARK MOORE PA-C

Provider Business Mailing Address
First Line	:	DEPT. #394
Second Line	:	P.O. BOX 1000
City	:	MEMPHIS
State	:	TN
Zip	:	38148-0001
Country	:	US
Telephone Number	:	941-300-4440
Fax Number	:	941-404-1760

Provider Business Practice Location Address
First Line	:	601 MATLOCK CENTRE CIR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-2535
Country	:	US
Telephone Number	:	817-693-1000
Fax Number	:	866-950-0295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	03/10/2025

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Directions to “ REMIS MARK MOORE PA-C” Practice Location

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