| Doctor Name: | DR. DOUGLAS R MOORE |
| NPI Number: | 1194729053 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 0102202087 |
| Business Practice Address: | 24211 Little Mack Ave St Clair Shores, MI - 480801151 |
| Business Phone Number: | 5864980440 |
| Business Fax Number: | 5864980401 |
| Mailing Address: | 24211 Little Mack Ave, ST CLAIR SHORES |
| State: | MI |
| Postal Code: | 480801151 |
| Phone Number: | 5864980440 |
| Fax Number: | 5864980401 |
| NPI Enumeration Date: | 06/09/2005 |
| NPI Last Update Date: | 11/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RC0000X |
| License Number: | 0102202087 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Cardiovascular Disease |
| Taxonomy Definition: | An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |