Healthcare Provider Details

I. General information

NPI: 1184215006
Provider Name (Legal Business Name): FLORIDA SEIZURE DOC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 03/12/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 CLAIRE LN STE 100
JACKSONVILLE FL
32223-6667
US

IV. Provider business mailing address

3003 CLAIRE LN STE 100
JACKSONVILLE FL
32223-6667
US

V. Phone/Fax

Practice location:
  • Phone: 904-226-7229
  • Fax:
Mailing address:
  • Phone: 904-204-6585
  • Fax: 850-390-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. OMAR JISHI MOORE
Title or Position: MD/OWNER
Credential: MD
Phone: 850-855-8764