MEDICARE: RICHARD B MOORE MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0048243	FL
2	207RC0000X	Cardiovascular Disease Physician	0101275204	VA
3	207RC0000X	Cardiovascular Disease Physician	ME0048243	FL
4	207R00000X	Internal Medicine Physician	0101275204	VA

General Provider Information

NPI Number	:	1376518142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD B MOORE MD PA

Provider Business Mailing Address
First Line	:	1020 VON PHISTER ST
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040-4830
Country	:	US
Telephone Number	:	772-713-1256
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 11TH CT # 104A
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5012
Country	:	US
Telephone Number	:	772-226-4830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	04/29/2025

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