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General NPI Number Information
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NPI Number | 1548248552
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Entity Type | Individual
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Provider Name | BRIAN ANDREW MOORE MD
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Gender | Male
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 307 BOATNER RD SUITE 114
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City | EGLIN AFB
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State | FL
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Zip | 32542-1391
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Country | US
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Telephone | 850-883-8264
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Fax | 850-883-8253
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Provider Business Mailing Address
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Address Line | 307 BOATNER RD SUITE 114
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City | EGLIN AFB
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State | FL
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Zip | 32542-1391
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Country | US
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Telephone | 850-883-8264
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Fax | 850-883-8253
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | L7051
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | MD.200570
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License Number State | LA
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