Provider Demographics
NPI:1457306581
Name:MOORE, ROBERT ALEXANDER III (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALEXANDER
Last Name:MOORE
Suffix:III
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 1:1302 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7503
Mailing Address - Country:US
Mailing Address - Phone:910-343-9800
Mailing Address - Fax:910-343-8650
Practice Address - Street 1:1302 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7503
Practice Address - Country:US
Practice Address - Phone:910-343-9800
Practice Address - Fax:910-343-8650
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-29351207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC60468OtherBC/BS-NC INDIVIDUAL
NC31-28888OtherUNITED HEALTH CARE
NC8960468Medicaid
NCC81954Medicare UPIN
NC60468OtherBC/BS-NC INDIVIDUAL
NC8960468Medicaid