Healthcare Provider Details

I. General information

NPI: 1326117433
Provider Name (Legal Business Name): RICHARD HAMPTON MOORE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 HIGHWAY 9 E # 235
LITTLE RIVER SC
29566-7833
US

IV. Provider business mailing address

1700 26TH AVE N
NORTH MYRTLE BEACH SC
29582-6110
US

V. Phone/Fax

Practice location:
  • Phone: 843-390-1333
  • Fax:
Mailing address:
  • Phone: 843-450-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number539
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: