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NPI Code Detail

MEDICARE: DR. GREGORY L MOORE MD

MEDICARE: DR. GREGORY L MOORE MD
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
1207Q00000XFamily Medicine PhysicianME0049537FL

General Provider Information

NPI Number : 1376526335
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY L MOORE MD
Provider Business Mailing Address
First Line : 2360 S HIGHWAY 29
Second Line :
City : CANTONMENT
State : FL
Zip : 32533-8508
Country : US
Telephone Number : 850-968-2083
Fax Number : 850-968-6024
Provider Business Practice Location Address
First Line : 2360 S HIGHWAY 29
Second Line :
City : CANTONMENT
State : FL
Zip : 32533-8508
Country : US
Telephone Number : 850-968-2083
Fax Number : 850-968-6024
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2005
Last Update Date : 03/25/2016

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