MEDICARE: MR. DOUGLAS ROBERT MOORE HAS, BC-HIS

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	237700000X	Hearing Instrument Specialist	AS2477	FL

General Provider Information

NPI Number	:	1528206950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS ROBERT MOORE HAS, BC-HIS

Provider Business Mailing Address
First Line	:	14840 MILITARY TRL
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8153
Country	:	US
Telephone Number	:	561-638-3110
Fax Number	:	561-638-3110

Provider Business Practice Location Address
First Line	:	14840 MILITARY TRL
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8153
Country	:	US
Telephone Number	:	561-638-3110
Fax Number	:	561-638-3110

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

Provider Enumeration Date	:	01/22/2009
Last Update Date	:	10/07/2011

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