Healthcare Provider Details

I. General information

NPI: 1548530868
Provider Name (Legal Business Name): DEBRA M MOORE DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HEIGHTS AVE
INVERNESS FL
34452-4573
US

IV. Provider business mailing address

155 HEIGHTS AVE
INVERNESS FL
34452-4573
US

V. Phone/Fax

Practice location:
  • Phone: 352-726-2460
  • Fax: 352-726-9134
Mailing address:
  • Phone: 352-726-2460
  • Fax: 352-726-9134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVM6626
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: