MEDICARE: DR. DARALL J MOORE DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO1999	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1891806667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARALL J MOORE DPM

Provider Business Mailing Address
First Line	:	4200 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33711-1140
Country	:	US
Telephone Number	:	727-321-8806
Fax Number	:	727-321-6838

Provider Business Practice Location Address
First Line	:	4200 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33711-1140
Country	:	US
Telephone Number	:	727-321-8806
Fax Number	:	727-321-6838

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/30/2014

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