Provider Demographics
NPI:1346338563
Name:MOORE, ROBERT HUGH (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:HUGH
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 SW CEDARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6818
Mailing Address - Country:US
Mailing Address - Phone:503-435-1550
Mailing Address - Fax:503-435-1435
Practice Address - Street 1:1075 SW CEDARWOOD AVE
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6818
Practice Address - Country:US
Practice Address - Phone:503-435-1550
Practice Address - Fax:503-435-1435
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09471204D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR11249OtherKAISER
OR00257004OtherBLUE CROSS BLUE SHIELD
OR11249OtherKAISER
OR234021Medicare ID - Type Unspecified