Doctor Name: | MARK MOORE |
NPI Number: | 1013385731 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | PAT9108991 |
Business Practice Address: | 1300 Miccosukee Rd Tmh, Bixler Emergency Center Tallahassee, FL - 323085054 |
Business Phone Number: | 8504310911 |
Business Fax Number: | |
Mailing Address: | 1300 Miccosukee Rd, Tmh, Bixler Emergency Center TALLAHASSEE |
State: | FL |
Postal Code: | 323085054 |
Phone Number: | 8504310911 |
Fax Number: | |
NPI Enumeration Date: | 09/11/2015 |
NPI Last Update Date: | 09/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PAT9108991 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |