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General NPI Number Information
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NPI Number | 1902167232
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Entity Type | Individual
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Provider Name | RICHARD JAMES MOORE D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 1702 S WAUKESHA ST
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City | BONIFAY
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State | FL
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Zip | 32425-3114
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Country | US
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Telephone | 850-547-9991
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Fax | 888-730-6946
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Provider Business Mailing Address
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Address Line | 1702 S WAUKESHA ST
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City | BONIFAY
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State | FL
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Zip | 32425-3114
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Country | US
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Telephone | 850-547-9991
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Fax | 888-730-6946
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | UO 3229
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS 12696
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License Number State | FL
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