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General NPI Number Information
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NPI Number | 1891962205
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Entity Type | Organization
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Legal Business Name | RICHARD B MOORE MD PA
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 787 37TH ST SUITE E140
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City | VERO BEACH
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State | FL
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Zip | 32960-7305
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Country | US
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Telephone | 772-299-0097
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Fax | 772-299-0165
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Provider Business Mailing Address
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Address Line | 787 37TH ST SUITE E140
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City | VERO BEACH
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State | FL
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Zip | 32960-7305
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Country | US
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Telephone | 772-299-0097
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Fax | 772-299-0165
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD B MOORE
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Credential | MD
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Telephone | 772-299-0097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME-0048243
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MO-0048243
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License Number State | FL
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