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General NPI Number Information
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NPI Number | 1629498282
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Entity Type | Individual
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Provider Name | BRIAN EDWARD MOORE JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 06/01/2020
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Provider Practice Location Address
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Address Line | CHERRY HOSPITAL 1401 WEST ASH ST
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City | GOLDSBORO
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State | NC
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Zip | 27512
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Country | US
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Telephone | 919-947-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 100 STRATFORD LAKES DR UNIT 122
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City | DURHAM
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State | NC
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Zip | 27713-3476
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Country | US
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Telephone | 919-260-9997
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2016-00565
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License Number State | NC
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