Provider Demographics
NPI:1033119037
Name:MOORE, ERIN M (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1824 KING ST
Mailing Address - Street 2:STE 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4735
Mailing Address - Country:US
Mailing Address - Phone:904-384-3343
Mailing Address - Fax:904-400-6671
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:STE 1804
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207
Practice Address - Country:US
Practice Address - Phone:904-398-3888
Practice Address - Fax:904-400-6675
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2022-11-23
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Provider Licenses
StateLicense IDTaxonomies
FLME1018632086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000999700Medicaid
P00718847OtherMEDICARE RAILROAD
GA167164085AMedicaid
FLBT183ZMedicare PIN
FL000999700Medicaid