Healthcare Provider Details

I. General information

NPI: 1215315569
Provider Name (Legal Business Name): KATHRYN PAX LATTIMORE MOORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UF HEALTH CENTER FOR MOVEMENT DISORDER AND RESTORATION 3450 HULL RD
GAINESVILLE FL
32607
US

IV. Provider business mailing address

406 HICKORY DR
CHAPEL HILL NC
27517-2910
US

V. Phone/Fax

Practice location:
  • Phone: 352-294-5400
  • Fax:
Mailing address:
  • Phone: 919-330-0546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME140340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: