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NPI Code Detail

MEDICARE: DR. ROBERT L MOORE M.D.

MEDICARE: DR. ROBERT L MOORE M.D.
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 Physician18036MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2315954200OTHERMSDOL FECA PROVIDER #

General Provider Information

NPI Number : 1841281276
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT L MOORE M.D.
Provider Business Mailing Address
First Line : 5604 OLD CANTON RD
Second Line :
City : JACKSON
State : MS
Zip : 39211-4217
Country : US
Telephone Number : 601-991-1044
Fax Number : 601-991-9868
Provider Business Practice Location Address
First Line : 5604 OLD CANTON RD
Second Line :
City : JACKSON
State : MS
Zip : 39211-4217
Country : US
Telephone Number : 601-991-1044
Fax Number : 601-991-9868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 04/18/2013

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Directions to “ DR. ROBERT L MOORE M.D.” Practice Location

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