Healthcare Provider Details

I. General information

NPI: 1831184456
Provider Name (Legal Business Name): MICHAEL DUANE MOORE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15004 CORTEZ BLVD
SPRING HILL FL
34613-6068
US

IV. Provider business mailing address

PO BOX 7386
HUDSON FL
34674-7386
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-4422
  • Fax: 352-597-2771
Mailing address:
  • Phone: 727-862-8383
  • Fax: 727-863-4766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS9217
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberOS9217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: