Healthcare Provider Details

I. General information

NPI: 1265767586
Provider Name (Legal Business Name): TIMOTHY ROGERS MOORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2009
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-1552
US

IV. Provider business mailing address

PO BOX 100183
GAINESVILLE FL
32610-0183
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-0140
  • Fax: 352-392-8217
Mailing address:
  • Phone: 352-392-0140
  • Fax: 352-392-8217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME167931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: