Healthcare Provider Details

I. General information

NPI: 1033119037
Provider Name (Legal Business Name): ERIN M MOORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DR STE 1804
JACKSONVILLE FL
32207
US

IV. Provider business mailing address

1824 KING ST STE 200
JACKSONVILLE FL
32204-4735
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-3888
  • Fax: 904-400-6675
Mailing address:
  • Phone: 904-384-3343
  • Fax: 904-400-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME101863
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: