MEDICARE: DOMINIC MOORE

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	363A00000X	Physician Assistant	14579	MN
2	363A00000X	Physician Assistant	1208270	FL
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1518542810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIC MOORE

Provider Business Mailing Address
First Line	:	8525 HIDDEN RIVER PKWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33637-1150
Country	:	US
Telephone Number	:	941-275-5951
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 HIGHWAY 13 E
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-6865
Country	:	US
Telephone Number	:	952-405-9760
Fax Number	:

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

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	03/02/2026

Similar Medicare Providers

1649912908 — ALYSSA JORDAN HABERER PA-C
Practice Location Address:

1601 HIGHWAY 13 E
BURNSVILLE, MN
55337-6865

Practice Phone: 952-405-9760
Practice Fax:

1306804455 — DR. MICHAEL EDWARD BERGSTEIN D.D.S.
Practice Location Address:

1601 HIGHWAY 13 E , SUITE 105
BURNSVILLE, MN
55337-6865

Practice Phone: 952-890-5450
Practice Fax: 952-707-1122

1497850374 — MRS. DEBORAH K NAGURSKI L.P.
Practice Location Address:

1601 HIGHWAY 13 E , STE. 101
BURNSVILLE, MN
55337-6865

Practice Phone: 952-895-9200
Practice Fax: 952-895-1946

1457456345 — MR. ROBERT L LOPNO L.P.
Practice Location Address:

1601 HIGHWAY 13 E , STE. 101
BURNSVILLE, MN
55337-6865

Practice Phone: 952-895-9200
Practice Fax: 952-895-1946

1609973874 — PAMELA J. BEYER PSY.D., L.P.
Practice Location Address:

1601 HIGHWAY 13 E , STE. 101
BURNSVILLE, MN
55337-6865

Practice Phone: 952-895-9200
Practice Fax: 952-895-1946

1265526412 — ROBERT J ELLISON L.P.
Practice Location Address:

1601 HIGHWAY 13 E , STE. 101
BURNSVILLE, MN
55337-6865

Practice Phone: 952-895-9200
Practice Fax: 952-895-1946

Directions to “ DOMINIC MOORE ” Practice Location

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