Healthcare Provider Details

I. General information

NPI: 1699906925
Provider Name (Legal Business Name): ROBERT A. MOORE, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SUPERIOR AVE STE. 202
NEWPORT BEACH CA
92663-3600
US

IV. Provider business mailing address

1501 SUPERIOR AVE STE. 202
NEWPORT BEACH CA
92663-3600
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-8070
  • Fax: 949-650-4585
Mailing address:
  • Phone: 949-764-8070
  • Fax: 949-650-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberG43085
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG43085
License Number StateCA

VIII. Authorized Official

Name: ROBERT ALLEN MOORE
Title or Position: OWNER
Credential: M.D.
Phone: 949-764-8070