Provider Demographics
NPI:1255490900
Name:MOORE, HOMER J JR (MD)
Entity Type:Individual
Prefix:
First Name:HOMER
Middle Name:J
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1121 NW 64TH TER
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4243
Mailing Address - Country:US
Mailing Address - Phone:352-331-3583
Mailing Address - Fax:352-331-3669
Practice Address - Street 1:1121 NW 64TH TER
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4243
Practice Address - Country:US
Practice Address - Phone:352-331-3583
Practice Address - Fax:352-331-3669
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2021-05-25
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Provider Licenses
StateLicense IDTaxonomies
TN508072084N0400X
WAMD.MD.603673242084N0400X
SD83132084N0400X
TXP45982084N0400X
CAG841792084N0400X
FLME426812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCW490ZMedicare PIN